workforce.com
March 2016
Focus
ANATOMY OF THE WORKPLACE
on Health
The human body’s a complex machine, so we examine what role HR plays in keeping workforces healthy — and running smoothly.
BACK STORY
How back pains are hurting performance.
WELLNESS 2.0 WORKING THROUGH IT
Making sense of thinking beyond dollars and cents.
Dealing with issues from arthritis to seizures.
# hellowork
Collaboration and success translate worldwide.
Creating a global workforce that maintains a local touch isn’t easy. ADP human capital management solutions utilize data-driven insights with innovative software to help you manage and connect your workforce, no matter where they live. Because taking pride in what you can accomplish together is a feeling that knows no borders. Visit adp.com/hellowork and see how we can provide a more human resource for your business.
ADP and the ADP logo are registered trademarks of ADP, LLC. ADP A more human resource. is a service mark of ADP, LLC. Copyright Š 2015 ADP, LLC.
Human Insights | Innovative Software | Happily Connected
RETURNING IN 2016
Local experts, practitioners and scholars return to the stage this spring to continue the discussion on the latest trending HR topics for our annual fast-moving, TED Talk-style speaker series.
6 CITIES. 50+ SPEAKERS. UNLIMITED IDEAS. APRIL Boston | April 14 Westin Copley Place New York | April 19 Westin New York at Times Square Washington, D.C. | April 28 InterContinental The Willard
SEPT. Chicago | Sept. 1 Four Seasons Hotel Chicago
• Thought-leadership • Practical tips • Inspiring stories • Industry-specific research
Register today, and rejoin us this spring!
Dallas | Sept. 7 Four Seasons Dallas at Las Colinas San Francisco | Sept. 22 The Ritz-Carlton, San Francisco
events.workforce.com/live
From Our Editors
READER FEEDBACK
Imagine someone offered you a sure-fire way to guarantee higher performance, boost engagement and improve productivity while simultaneously driving down costs.You’d be all ears, right?You’d probably be skeptical, too. The answer’s not as far-fetched as you might imagine. In fact, it’s already within your reach. This month, starting on p. 28, Workforce focuses on health at work with a special issue dedicated to exploring what has been ailing your workforce. From aching backs and stress headaches to slumping productivity and everything in between, the total economic cost of poor health is $589 billion annually in the U.S. alone, according to the Integrated Benefits Institute. In this issue, we take a look at what HR can do to help. It’s high time employers acknowledged that some workers aren’t just sick of work — work is actually making them sick. — Mike Prokopeak, Editor in Chief 4
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Reader Terry Oldberg had this to say about a recent story titled “The Scientific Method: Sell STEM to U.S. Students” posted on Workforce.com: That ‘the United States economy is suffering from a lack of qualified STEM candidates for science, technology, engineering and mathematics jobs’ is a statement that artfully evades the issue of the wages that are offered for the labor.The shortage is of $10 per hour STEM workers.There is no shortage of $100 per hour STEM workers. Workforce.com/STEMStudents
These letters were sent to Associate Editor Sarah Sipek after her story “Caring for the Caregivers” appeared in the January issue of Workforce, P. 28: I can’t express how delighted I am to see that elder care caregiving challenges for employees is getting more attention.Thank you very much for your on-point article. I’ve been beating this drum since I completed my master’s thesis for gerontology in which I focus on employees who do double duty as elder caregivers and how it affects them and the company. In the past some company executives would not even have me speak to their employees about elder care and how they can be helped. Executives have usually told me, ‘Veronica, you have a great idea here, but you are way ahead of your time.’ Really. They couldn’t see what was happening right under their nose. Today I still perform consulting but most of it is what I refer to as ‘front door’ geriatric care management. I am a professional member of the Aging Life Care Association and would spend a specific number of hours in which to assist them ‘find the right rooms to visit’ once I get them through the ‘front door.’ —Veronica Woldt, Corporate Eldercare Solutions, Franklin,Wisconsin I really appreciated your article on caring for caregivers. It’s an incredibly important topic we need to address in society. Unfortunately, I feel like you overlooked a huge piece of this caregiver puzzle: parents of children with special needs. We parents of children with special needs are often hidden in the shadows and scrambling just to get through each day. And when it’s
your child who needs you to be a full-time caregiver, it can be hard to find additional support (unlike when it is a parent you are caring for, since people often have siblings they can lean on to share the burden). And, quite frankly, when it’s your child who has special needs, you know you are looking at the rest of your life as a caregiver. —Laura Francis, River Software, Greenwood Village, Colorado Workforce.com/Caring
The story in the January issue titled “Pavlov’s Dog … Didn’t Have Pet Insurance,” p. 16, drew these responses: RAWLCM said: My wife’s company recently started offering pet insurance as a ‘benefit.’ The cost of premiums through her company was exactly the same as was offered to the public on the pet insurance company’s website. I’ve found this to be true of a lot of optional ‘benefits.’ They offer nothing the employee can’t get on their own, but the employer gets a kickback for every employee who signs up. Another difference between pet insurance and pet wellness plans is that the wellness plans cover pets of all ages, where the insurance usually cuts off coverage for mature animals.
To which Markovian responded: I’m an HR professional, and I question whether there’s any ‘kickback’ to the employer for offering pet insurance, even if the premiums are the same as on the carrier’s website. In fact, it’s probably ‘costing’ the employer in terms of administration of the plan, even if the employees are fully paying the premium via payroll deduction. It takes time to reconcile the invoices, process payment, mail the payment to the carrier, maintain documentation about the plan, communicate it to employees, answer their questions about it, etc. Benefits are an expense to an employer, not a source of revenue (unless there happens to be something shady going on). Workforce.com/PavlovsDog We welcome your comments on these stories and others on our website. Be sure to follow us and give us a shout on Twitter at @Workforcenews, too. Hope to hear from you! march
2016
THE HR CONFERENCE OF THE
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Register 3 or more attendees at the same time, and each will receive $100 off! Questions? Contact conferenceteam@workhuman.com
webinars Workforce
is pleased to offer live and on-demand webinars!
FREE LIVE
ONLINE EVENTS The Dollar Value of Streamlining HR Processes. Build Your Case for Change. Thursday, March 10 2 PM ET
Why Retention Is an Outcome — But Not the End Goal — of Employee Engagement Wednesday, Feb. 24 2 PM ET
Available live on airdate and on-demand for one year after unless otherwise specified. Check them out today and keep the education going!
workforce.com/webinars
March 2016 | Volume 95, Issue 3 PRESIDENT John R. Taggart jrtag@workforce.com
COPY EDITOR Frannie Sprouls fsprouls@workforce.com
EXECUTIVE VICE PRESIDENT, CREATIVE SERVICES Gwen Connelly gwen@workforce.com
EDITORIAL INTERNS Andie Burjek aburjek@workforce.com
Joe Dixon jdixon@workforce.com VICE PRESIDENT, CFO, COO VICE PRESIDENT, Kevin A. Simpson RESEARCH AND ksimpson@workforce.com ADVISORY SERVICES VICE PRESIDENT, Sarah Kimmel GROUP PUBLISHER skimmel@workforce.com Clifford Capone ccapone@workforce.com VICE PRESIDENT, EDITOR IN CHIEF Mike Prokopeak mikep@workforce.com EDITORIAL DIRECTOR Rick Bell rbell@workforce.com GROUP EDITOR/ ASSOCIATE EDITORIAL DIRECTOR Kellye Whitney kwhitney@workforce.com
RESEARCH MANAGER Tim Harnett tharnett@workforce.com RESEARCH ANALYST Grey Litaker clitaker@workforce.com RESEARCH ASSISTANT Kristen Britt kbirtt@workforce.com EDITORIAL DESIGNER Anna Jo Beck abeck@workforce.com
MANAGING EDITOR James Tehrani jtehrani@workforce.com
WEB COORDINATOR Sam Dietzmann sdietzmann@workforce.com
CONTRIBUTING EDITOR Frank Kalman fkalman@workforce.com
MEDIA MANAGER Ashley Flora aflora@workforce.com
ASSOCIATE EDITORS Lauren Dixon ldixon@workforce.com
VICE PRESIDENT, EVENTS Trey Smith tsmith@workforce.com
Bravetta Hassell bhassell@workforce.com Sarah Sipek ssipek@workforce.com
EVENT CONTENT MANAGER Ashley (Wynne) Collins awynne@workforce.com
John R. Taggart PRESIDENT
WEBCAST COORDINATOR BUSINESS ADMINISTRATIVE Alec O’Dell MANAGER aodell@workforce.com Melanie Lee BUSINESS MANAGER mlee@workforce.com Vince Czarnowski LEAD GENERATION vince@workforce.com ADMINISTRATOR REGIONAL SALES MANAGERS Derek Graham dgraham@workforce.com Marc Katz mkatz@workforce.com Daniella Weinberg dweinberg@workforce.com ACCOUNT EXECUTIVE Brian Lorenz blorenz@workforce.com DIRECTOR OF BUSINESS DEVELOPMENT, EVENTS Kevin Fields kfields@workforce.com
Nick Safir nsafir@workforce.com
CONTRIBUTING WRITERS Nicole Baldwin Marty Denis Cary E. Donham Kris Dunn Sarah Fister Gale Charlotte Huff Jon Hyman Mark T. Kobata Patty Kujawa Rita Pyrillis
AUDIENCE DEVELOPMENT DIRECTOR Cindy Cardinal ccardinal@workforce.com DIGITAL SPECIALIST Lauren Lynch llynch@workforce.com MARKETING MANAGER Taylar Ramsey tramsey@workforce.com MARKETING ASSOCIATE Max Mihelich mmihelich@workforce.com LIST MANAGER Mike Rovello hcmlistrentals@infogroup.com
Gwen Connelly EXECUTIVE VICE PRESIDENT
Kevin A. Simpson CHIEF FINANCIAL OFFICER CHIEF OPERATING OFFICER
Norman B. Kamikow CO-FOUNDER (1943 - 2014)
WORKFORCE EDITORIAL ADVISORY BOARD Arie Ball, Vice President, Sourcing and Talent Acquisition, Sodexo Angela Bailey, Associate Director and Chief Human Capital Officer, U.S. Office of Personnel Management Kris Dunn, Chief Human Resources Officer, Kinetix, and Founder, Fistful of Talent and HR Capitalist Curtis Gray, Senior Vice President, Human Resources and Administration, BAE Systems Jil Greene, Vice President, Human Resources and Community Relations, Harrah’s New Orleans Ted Hoff, Human Resources Vice President, Global Sales and Sales Incentives, IBM Tracy Kofski, Vice President, Compensation and Benefits, General Mills Jon Hyman, Partner, Meyers, Roman, Friedberg & Lewis Jim McDermid, Vice President, Human Resources, Cardiac and Vascular Group, Medtronic Randall Moon, Vice President, International HR, Benefits and HRIS, Lowe’s Cos. Dan Satterthwaite, Head of Human Resources, DreamWorks Dave Ulrich, Professor, Ross School of Business, University of Michigan Workforce, ISSN 2331-2793, is published monthly by MediaTec Publishing Inc., 318 Harrison Street, Suite 301, Oakland, CA 94607. Periodicals Class Postage paid at Oakland, CA and additional mailing offices. POSTMASTER: Please send address changes to: Workforce magazine, P.O. Box 8712, Lowell, MA 01853. Subscriptions are free to qualified professionals within the U.S. and Canada. Nonqualified paid subscriptions are available at the subscription price of $199 for 12 issues. All countries outside the U.S. and Canada must be prepaid in U.S. funds with an additional $33 postage surcharge. Single copy price is $29.99. Workforce and Workforce.com are the trademarks of MediaTec Publishing Inc. Copyright © 2016, MediaTec Publishing Inc. ALL RIGHTS RESERVED. Reproduction of material published in Workforce is forbidden without permission. Printed by: Quad/Graphics, Sussex, WI
CONTENTS
28-47
Focus on Health 30 YOUR ACHING BACKS
38 WELCOME TO WELLNESS 2.0
32 BONUS: DEALING WITH COMMON
42 HEALTH, DENTAL & VISION PROVIDERS 47 ROADMAPS
Some employers have decided to be proactive about reducing back pain to help workers cope.
AILMENTS AND CONDITIONS
Experts weigh in on what employers can do to help their workers.
8
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Companies are spending less time worrying about the elusive return on their wellness programs.
The challenge is to drive interest so more people use these benefits.
44 HOT LIST
Health, dental and vision insurers.
How to plan, do and review your wellness program.
march
2016
ON THE WEB SPEAK UP!
30
The Workforce online community provides you with virtual meeting places to chat about issues and trends affecting you and your workplace.
TRENDING
LIKE US: facebook.com/workforce.magazine
10 HAIL TO THE CHIEF ECONOMISTS
FOLLOW US: twitter.com/workforcenews
38
JOIN THE GROUP: workforce.com/LinkedIn
WATCH US:
The latest hiring trend among tech firms is to add economists.
10 DEAR WORKFORCE
Work-life balance; retention.
workforce.com/youtube
FOR YOUR BENEFIT COLUMNS 4
YOUR FORCE
Workforce focuses on health in this special issue on ailments at work.
14 WORK IN PROGRESS
Hiring a white guy as your diversity leader.
20 BENEFITS BEAT
Facing the realities of high-deductible health plans.
26 THE PRACTICAL EMPLOYER
Protecting yourself from the pain.
50 THE LAST WORD
Wellness, schmellness.
march
2016
16 DOUBLING DOWN ON PHARMA COSTS To curtail the high cost of specialty drugs, some companies are turning to usage restrictions.
17 A MINER, NOT A MINOR, PROBLEM
Substance abuse among miners and construction workers highest in the country., study finds.
17 A HEALTHY BOTTOM LINE
A recent study suggests that there is a connection between a healthy workforce and a healthy bottom line.
18 401(K)S WILL FEEL FED’S RATE HIKE The Fed raised its benchmark rate recently, which can affect 401(k) retirement plan account balances.
11 FROM THE WEB, PEOPLE MOVES AND BY THE NUMBERS
Annual reviews; Morales to Sidley Austin; skinny on wellness.
12 TEACHING LEADERSHIP Our Q&A with author John Addison.
12 ANNUL THE ANNUAL SURVEY?
Most survey respondents said annual check-ins aren’t sufficient.
LEGAL 24 NAVIGATING EMPLOYEE WELLNESS PROGRAMS
The legal landscape is evolving.
25 LEGAL BRIEFINGS
Hush-hush on nondisclosure; protected activity.
w o r k f o r c e . c o m | Workƒorce
9
TRENDING
Hail to the Chief Economists By Sarah Fister Gale
I
f you are a tech company,“economist” might be your next hardest job opening to fill, at least if you want to generate real value from your customer data. The latest hiring trend among tech firms is to add economists to their ranks as a way to close the gap between the numbers their data scientists are churning out and what it actually means for their clients. “It’s a popular move in this era of data science,” said Josh Wright, the new chief economist for iCIMS Inc., the cloud-based recruiting software provider. ICIMS has amassed a huge amount of talent acquisition data from its users, which can be an incredible source of value, he said. “But only if we can provide insight into what it means.” Finding the story behind the numbers is why the company hired Wright, said Susan Vitale, chief marketing officer at iCIMS. “When we publish research, the first question everyone asks us is, ‘why?’ ” she said. For example, “Why does it take so long to fill key tech roles?” or “Why should I care about a dip in the labor market?” “Understanding the connection between the data and the business is what makes that data meaningful,” Vitale said.
‘ECONOMISTS CAN … UNCOVER THE HIDDEN INSIGHT IN THE DATA.’ —ANDREW CHAMBERLAIN, GLASSDOOR Wright, a former U.S. economist with Bloomberg Intelligence in New York, has only been with iCIMS since January, but he already has a list of goals to scour existing data sets to identify trends and provide additional perspective to the talent acquisition research the company conducts through its Hire Expectations Institute. “We have a ton of data that we want to explore,”Vitale said. “Josh will help us understand what is relevant and what will be the most interesting to our customers.” And iCIMS isn’t the only firm creating this new role. Tech firms such as Glassdoor Inc., Redfin and Zillow Group are among the industry players that have added chief economist positions. Also, companies such as eBay Inc. and Pandora Media Inc. have hired groups of economists from think tanks, government agencies and global consultancies to bring new insight in the reams of data they accumulate and analyze. The annual salary range seems to vary as organizations grapple with the position’s value, according to several websites. Job aggregator Indeed lists the position at $147,000 in New York while Salary Expert lists the average salary for a chief economist at $158,639 in the United States. While this is still a relatively new trend in the human resources tech world, it is likely to continue as these service providers realize the value they have in the customer data they hold, said Andrew Chamberlain, chief economist at Glassdoor, the employer review, jobs and recruiting site. “Economists can complement the work of the data scientists, and uncover the hidden insight in the data that will surprise people and generate a lot of attention.” 10
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Dear Q: How Do We Get a Handle on Work-Life Balance? Work-life balance for many employees is way out of whack. We want to get a handle on this before things go south on us. —Rebalancing the Scales, HR manager, Kingston, New York A: Dear Rebalancing: Right now, you have talented people in your organization who have risen to the challenges that a bump in business has presented. But it may also be true that many of these individuals may not be in the right jobs in the first place. In this pressurized environment, that means manageable stress in the job has been exacerbated — throwing work-life balance out of whack. In our research, we’ve found that the larger the gap between an individual’s core skills, behavioral style and motivators and the skills, behavioral style and motivators required for the job, the higher the stress. So, for the first attempt to address work-life balance, think about whether you have the right people in the right jobs. Validate the work your team has done but review their job responsibilities — and the responsibilities added to the job since things got hectic. You might discover in this process that some of your jobs might require a person to be all things to all people. If this is the case, you must re-engineer that job. Placing people in jobs that require them to be all things to all people is a road map for burnout. To bring about balance, start by relieving that pressure. Source: Bill Bonnstetter, TTI Success Insights, Scottsdale, Arizona
Q: How Do Benefits Factor Into Retention? In addition to salary and compensation, shouldn’t this beg the question: How do nonsalary/compensation benefits factor into the retention equation? Ought we also address the noncompensation and cultural aspects of retention as well? —Big Picture, HR services, Illinois A: Dear Big Picture: You can follow this data path to the very best possible answer. Each year, Fortune magazine names the top 100 companies to work for and fills page after page with the great benefits they offer. Google Inc. has been No. 1 six times and has been cited for offering horseshoe pits and free eyebrow shaping. We also know that publicly traded companies that make that list have shareholder returns that are 366 percent higher than their counterparts. Is the free eyebrow-shaping benefit the reason for such high profits? Hardly. A deeper dive reveals that two-thirds of the scores are based on the Great Place to Work’s Trust Index survey, which measures how much each employee trusts a direct supervisor. What are the factors that drive engagement, retention and profits? It’s a simple, if not sexy, reason: An organization’s employees trust their bosses. Source: Dick Finnegan, C-Suite Analytics, Longwood, Florida
march
2016
TRENDING
FROM THE WEB
REVIEWING THE ANNUAL REVIEW In a recent edition of the series “5 Minutes of Management,” Workforce editors Rick Bell and Frank Kalman chat about the merits of annual performance reviews. They also provide some thoughts on wearable devices in the workplace and offer up some bold 2016 predictions. Workforce.com/ AnnualReview JACKPOT? In light of the billion-dollar-plus Powerball lottery earlier this year, blogger James Tehrani mused that while every situation is different, there are examples of lawsuits that started over office pools that won lotteries.What’s an employer to do? Workforce.com/ Powerball THE EEOC AND WELLNESS As employers continue to search for ways to battle the high and ever-rising cost of medical insurance, blogger Jon Hyman says the case of EEOC v. Flambeau Inc. offers hope that mandatory wellness programs will remain a viable option. Still, he adds, “This opinion is not, by a long shot, the final word on this issue.” Workforce.com/ FlambeauCase march
2016
PEOPLE
moves
ROSEVELIE MÁRQUEZ MORALES Chicago-based law firm Sidley Austin named Rosevelie Márquez Morales as its East Coast diversity director. Morales is a co-chair of the New York State Bar Association’s Committee on Diversity and Inclusion, and a past president of the Puerto Rican Bar Association. Morales was most recently a litigation partner at the law firm Harris Beach. RICHARD FLOERSCH The Center on Executive Compensation named Richard Floersch as senior strategic adviser. Floersch will focus on shaping the center’s program of work and education initiatives. He previously served as executive vice president and chief human resources officer at McDonald’s Corp. for more than a decade. LEIGH HARRIS Employee benefits consultancy Lockton Dunning Benefits named Leigh Harris as vice president of its health and welfare practice. Harris has been consulting employers for eight years in all aspects of health and welfare. She currently sits on the board of directors for Friends of Wednesday’s Child, a nonprofit focused on improving educational outcomes for foster children. To be considered for People Moves, email a brief announcement and a high-resolution color photo to editors@workforce.com. Include People Moves in the subject line.
By the Numbers compiled by Rick Bell
The Skinny on Wellness Wellness is big business, but it’s not a stretch to say employers that make wellness a priority can save money in the long run.
National corporate wellness services industry
businesses
workers
5,655 44,209 Source: Denver Business Journal
Weighty
Gain
8.4
annual % Projected industry revenue growth
Source: Fortune, April 2015
Massachusetts
4.8%
California 13.6%
States with the most corporate wellness-focused companies
10.4%
Texas
Florida New York
6.3
6.5%
%
Source: Denver Business Journal
Healthy, 1 Programs are practical and accessible. Happy The work environment is 2 Workers health-conscious. Signs you have a successful corporate wellness program Source: Fortune, April 2015
is integrated into 3 Wellness the company’s structure. is linked to 4 Wellness existing support programs. screenings and 5 Health education are offered.
The Spend
The ROI
Employers spent an average of $693 per employee on wellness-based incentives $693 in 2015. $594
$430 2010
2014
2015
Source: Fidelity Investments and the National Business Group on Health, 2015
Source: Society for Human Resource Management, “The Real ROI for Employee Wellness Programs,” February 2015
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11
TRENDING
Annul the Annual Survey? By Andie Burjek
HIS PURPOSE: TEACHING LEADERSHIP By Rick Bell
L John Addison, author
Leadership is an elusive quality. Yet after 25 years at Primerica Inc., John Addison is in a position to offer his insights into what makes a good leader. Addison, author of “Real Leadership: 9 Simple Practices for Leading and Living With Purpose,” served as co-CEO of Primerica Inc. from 1999 to 2015 and played a pivotal role in steering the company through changes including its separation from Citigroup Inc. in 2009. Rick Bell caught up with Addison, now president and CEO of Addison Leadership Group, via email. Workforce: How do you teach leadership? John Addison: Leadership needs to be modeled. It’s hard to teach leadership as if it is in front of a classroom. The best way to teach it is to model it day to day so they can watch what you do and how you do it. Leadership is not just about telling people what to do; it’s more about showing people what to do and why they’re doing something. As a leader, you’re making tough decisions; not everyone is going to be happy. But if you’re developing people under you, it’s important they understand what and how you’re doing it.
WF: Is ethics lacking among the institutions that teach leadership? Addison: Yes. Too often, processes are taught instead of ethics. Leadership isn’t taught, particularly in business school, as most just offer courses in marketing, management, etc., but too often among schools the focus is too process-oriented on running the business vs. how your behavior or ethics should be. When you become a serious business leader, there is an ethical piece to what you’re doing — in addition to the shareholder value.
WF: We often hear the term, born leader. Urban legend or fact? Addison: Both are true. There are people who are born with leadership traits. They are not necessarily born as leaders, but have the necessary characteristics. Some people are born with more communication skills or certain talents (i.e., more natural people person), but these traits are not the actual ‘proof in the pudding’ of leadership. You can still achieve success with these traits by learning them. Real leadership is more learned and earned than occurring through natural selection and DNA.
WF: Do you find that men lead differently than women or is there a common thread that runs through both sexes? Addison: While there is a difference, I’m not sure how much is from DNA vs. how we’re socialized. In general, women are better at socialization while men are more bureaucratic. But from my experience, I’ve really seen no difference based on someone being male or female in their leadership. Quite often, women have more empathy than men, which I see as a great skill of a leader — to be empathic and understand where people stand and the issues they face. Whether you are a man or woman though, a great leader is a great leader. It often has more to do with their traits and what they’re made of.
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isten to this: No relationship should be one-sided, and that’s especially true between employers and employees. Unfortunately, that can happen when a company relies on the traditional annual survey for employee feedback, said Michael Papay, CEO of Waggl Inc., an employee feedback platform A recent Waggl survey asked if listening to employees and incorporating their ideas is critical to an organization’s success, and 97 percent said yes, but only 38 percent of the 550 business leaders surveyed thought an annual check-in is sufficient. When it comes to communication with employees, there seems to be a disconnect between what leaders want and what they have, Papay said. “Organizations need leaders and managers who are equipped to have more frequent conversations,” he said. The annual survey, still a popular option for eliciting feedback, provides only a one-directional flow of information. In an annual survey, a company develops the questions and the answers from which to select, and the process doesn’t promote dialogue, he added. Many companies fall in this trap of seeing the survey purely as a metric and not using the data in the right way, added Adam Pressman, global director of client partnership at Sirota Consulting. “This results in a focus on the ‘engagement score’ and the benchmarks around that score vs. a real focus on understanding the story behind the data and the insights that can lead to positive change,” he said. Managers and leaders need to be trained and prepared to take action with the data, he added. They need to speak to employees about the insights on engagement that a survey provides, understand the problem and change what’s not working. A listening culture “builds trust in the workforce,” Papay said. march
2016
march
2016
w o r k f o r c e . c o m | WorkĆ’orce
13
TRENDING
Wo r k i n P r o g r e s s
HIRING A WHITE GUY AS YOUR DIVERSITY LEADER By Kris Dunn
I
f there’s anything that gets people riled up, it’s race.That’s Your hiring manager doesn’t want to do it, and he or she why the recent move by Twitter to hire a white guy, Jeffrey is bitching about it.You’re faced with the classic Catch-22. Siminoff, as the company’s new diversity leader is so interest- You either force the process and risk looking like a bureauing — and explosive. crat, or you let hiring managers do their thing without inFirst up, the question of whether your diversity chief terviewing a diverse candidate, which is undoubtedly bad needs to hail from a protected class gets the juices flowing for the long-term diversity of your workforce as well as in a way few topics can. Most of us believe that the best your goal of hiring the best talent. candidate for any job should be selected, right? I’m a moderate Republican and, as you’ve probably noNot so fast, my friends. It’s America — and that means ticed, white. You might think I would vote to allow the you’re in a country with decades of baggage related to hir- hiring manager to skip the diverse candidate interviews ing practices, corporations with that profile, right? that look like country clubs But I wouldn’t, and here’s and distrust from all sides. why. I’ve learned that for Need proof? Tell your avevery 10 interviews you erage white male over 35 in make hiring managers do America that Twitter should against their will, they are have hired a person of color going to get two to three as its diversity chief and wait pleasant surprises. That for the fireworks. means they’re impressed Most white people served enough by the candidate in by HR professionals think question that they’ll change of affirmative action when their mind and offer them they hear the word diversity. Most organizations are full of the job, or they’ll put the memory on reserve and as a rewhite people and have a greater business need for diversity. sult hire them for a future role. Those two facts are key when determining whether a Both outcomes don’t happen unless you force the hiring white person can lead diversity efforts at your company. manager to conduct the diverse interview. And the surprise Let’s take two well-known organizations — the NFL can help change attitudes and mindsets in your company. and Facebook — and dig into their initiatives to increase Can a white guy lead your diversity practice? My take is diversity to understand why optics matter. you need a nonwhite person as your diversity leader, but that The NFL has the Rooney Rule. It mandates that any person has to be worldly enough to expand the definition of football team in the league filling a head coaching position diversity at your company as soon as he or she walks in the must interview at least one minority candidate. Named door.The person can’t be what the majority expects. after the Pittsburgh Steelers’ owner Dan Rooney, chairman You and I know that diversity transcends race. But that’s of the league’s diversity committee, the rule was created in because we’re classically trained.Your managers hear diverthe hopes of increasing the number of minority head sity and think race. And that’s exactly why your diversity coaches in the league. leader should not be white but progressive in his or her Facebook borrowed this concept in 2015 and imple- definition of diversity. mented a policy of having at least one minority candidate There’s no surprise in a nonwhite person being named interview for open positions as well. Sounds like affirmative as your diversity leader. It’s what happens next that is key. If action, right? It’s not; it’s more about the realities of selection your nonwhite diversity leader presents a broader context/ bias and forcing hiring managers to surprise themselves. business case for diversity that transcends race and backs it On many occasions, hiring managers have a candidate in up with action, he or she has a greater chance for success. mind that they want to plug into a job. When this happens, White people can do a good job as diversity officers at they’re usually so set on the decision that they think any other your company. Nonwhite people can do it better — as interviews (even internal candidates) may be a waste of time. long as they make diversity about more than race. The tough part about that is that your company still has It’s all about surprising the narrow-minded people in a process, and the hiring manager needs to put forth a little your organization. more effort. If you’re like the NFL and Facebook, you might plug in a diversity candidate and mandate an inter- Kris Dunn, the chief human resources officer at Kinetix, is a Workforce view even if the hiring manager objects. contributing editor. To comment, email editors@workforce.com.
I’VE LEARNED THAT FOR EVERY 10 INTERVIEWS YOU MAKE HIRING MANAGERS DO AGAINST THEIR WILL, THEY ARE GOING TO GET TWO TO THREE PLEASANT SURPRISES.
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15
FOR YOUR BENEFIT
Employers Doubling Down on Pharmacy Costs To curtail the high cost of specialty drugs, some companies are turning to usage restrictions. By Rita Pyrillis
E
mployers that were blindsided in recent years by the cost of new specialty drugs to treat conditions such as arthritis, cancer and hepatitis C are shaking off the sticker shock and getting more aggressive about managing their pharmacy benefits. According to a December 2015 report by Towers Watson & Co., now Willis Towers Watson, 53 percent of employers have added new coverage and usage restrictions for specialty prescription drugs, including prior authorization or limiting quantities based on clinical evidence. And another 32 percent are expected to add restrictions by 2018. Among those companies is 84 Lumber Co. in Eighty Four, Pennsylvania, which launched a prior authorization requirement for compound drugs. Mark Mollico, vice president of human resources said in an email that his company also raised its copayments on specialty drugs and is limiting quantities to a 30-day supply. 84 Lumber, which employs 4,200 people in 250 stores across 30 states, saw its specialty drug spending skyrocket by 94 percent between 2013 and 2014 because of hepatitis C medications. Mollico said specialty drug spending in 2015 accounted for 26 percent of the company’s prescription drug costs, up from 22 percent the previous year. “Predicting the specialty increase is hard,” he said. “Each year more and more specialty medications are coming on the market.”
‘THIS IS WHAT’S KEEPING BENEFITS MANAGERS UP AT NIGHT.’ —SHARI DAVIDSON, NBGH
The 20th annual Towers Watson/National Business Group on Health Best Practices in Health Care Employer Survey also found that more employers plan to exclude certain compound medications from their benefit coverage, with 39 percent having already done so and another 24 percent expected to by 2018. Compounds are drugs that have been mixed or altered, most often by a pharmacist, to customize a medication for a specific patient. The process leads to higher costs, and the U.S. Food and Drug Administration might not approve the resulting medication, according to the report. “In the past five years, you’ve seen almost all employers embrace prior authorization and step therapy, which is a first-line approach,” said Eric Michael, a pharmacy practice leader at Willis Towers Watson in Minneapolis. “Now you are seeing the next evolution with the exclusion of certain compound medications. You can cut costs by 30 percent this way. It’s a much 16
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more heavy-handed approach than what you were seeing five years ago, but employers’ bank accounts are only so big.” With specialty drug costs expected to grow by 22.3 percent in 2016 compared with 3.9 percent for traditional medications, employers are finding a variety of ways to manage their specialty drug costs, according to a recent report by the NBGH. In addition to the more common practices of requiring prior authorization under the pharmacy plan, step therapy, which requires patients to try cheaper medications before being approved for costlier options, and limiting quantities based on clinical evidence, employers are also trying other approaches. More than half are using freestanding specialty pharmacies to fill prescriptions and requiring prior authori-
‘EMPLOYERS’ BANK ACCOUNTS ARE ONLY SO BIG.’ —ERIC MICHAEL, WILLIS TOWERS WATSON
zation under the medical plan in addition to the pharmacy plan, and 35 percent are using price transparency tools for specialty drugs, according to the 2016 NBGH plan design survey report of large employers. More aggressive tactics are necessary as employers brace for the next wave of blockbuster drugs to hit the market, according to Shari Davidson, the NBGH’s vice president.The most recent class of blockbuster drugs approved by the FDA is PCSK9 inhibitors, which are injectable drugs that treat high cholesterol. A treatment course costs more than $14,000 a year per patient, dwarfing the cost of statins, which are $4 per month, according to the NBGH. “With each new category of drug that comes out, employers are looking to see which approach makes the most sense,” Davidson said. “Is it prior authorization? Should we work with the PBM [pharmacy benefit manager] or negotiate directly with the manufacturer? As these drugs come out, employers are trying to help employees. There are a ton of oncology drugs that are expected to come out in a year or two. This is what’s keeping benefits managers up at night.” Adding to the problem is the escalating cost of compound medications. According to the NBGH study, annual compound drug costs spiked by 128 percent in 2014. Half of the NBGH members surveyed indicated that, starting in 2016, compound medications will be subject to prior authorization, 24 percent will require the use of traditional medications before using compounds, and 22 percent will impose quantity limits. march
2016
FOR YOUR BENEFIT
There’s a Miner Problem, Not a Minor Problem
A Healthy Workforce, a Healthy Bottom Line?
Substance abuse among miners and construction workers highest in the country.
Study finds wellness, stock connection.
By Sarah Sipek
M
iners and construction workers lead the nation in substance and alcohol abuse, according to a recent report by the U.S. Department of Health and Human Services. While potentially devastating to such stalwart industries of the U.S. economy, the problem of drug and alcohol abuse in the workplace is not confined to blue-collar workers, said Will Wesch, director of admissions for the Novus Medical Detox Center in Florida. “It’s very easy for one to say that, in a high-tech world, pressures with jobs and deadlines and things like that, people may resort to alcohol or drugs to escape,”Wesch said. “I personally think it’s been going on a lot more than we think it has in the past. It’s just that people are becoming more aware of it.” According to the study, which was released last December by the Substance Abuse and Mental Health Service Administration, a branch of HHS, about 18 percent of mining industry employees and roughly 17 percent of construction industry employees admitted to heavy alcohol use. “We are aware of the growing problem within our industry,” said Dana Bennett, president of the Nevada Mining Association. “Stricter drug-testing policies and incentives for employers to effectively carry out the tests are necessary to keep our employees safe. Both employers and mining employees need better education in terms of recognizing the warning signs that someone may be abusing drugs or alcohol.” The Americans with Disabilities Act provides employees with some protections from termination when approaching their employer regarding substance-abuse problems. However, that doesn’t take away the stigma of being labeled as “having a problem,” Wesch said. Employee assistance programs also offer a measure of confidentiality for employees who want to open up about their substance abuse, he said. “It’s very hard for someone to come up and tell the owner or the boss that they’re abusing a drug without the worry of being fired or looked down upon,” Wesch said. “Employees need a confidential person they can go to when they recognize they need help.” EAPs, for instance, give employees experiencing a problem an outlet to call to gain access to services such as long-term rehabilitation, counseling and even sober buddies. march
2016
By Rita Pyrillis
T
he debate over how much return on investment corporate wellness programs can generate will likely rage on, but a recent study suggests that there is a connection between a healthy workforce and a healthy bottom line. After analyzing data from 45 publicly traded companies with top-shelf wellness programs, the Health Enhancement Research Organization found that stocks of those companies appreciated 235 percent over a six-year period compared with 159 percent for the High Performers Standard & Poor’s 500 Index. The in- In a recent study, companies that invested in comprehensive wellness dex tracks 500 large programs outperformed the S&P 500 publicly traded in 16 out of 24 quarters. companies and is the most commonly used measure of the U.S. stock market. “We’re not saying conclusively that if Source: HERO wellness study 2016 you want X amount of return you should invest in wellness, but we can say with confidence that companies that are preforming well on the stock market have this one thing in common: They have high-performing wellness programs,” said Jessica Grossmeier, study co-author and vice president of research at HERO, a nonprofit organization that focuses on employee health management research. The study evaluated the stock performance of companies that scored highest on the HERO Scorecard, an online tool that helps employers assess the strengths and weaknesses of their wellness programs. The online survey was launched with Mercer in 2009 to “create a list of best practices that companies could benchmark against,” according to Steven Noeldner, a study co-author. Grossmeier emphasized that the survey results merely point to a correlation between stock performance and investment in health and wellness programs, but employers should take note. “We can’t say that if you invest in wellness your stock is going through the roof, but this study allows us to say that there are broader reasons for doing this than health care cost containment,” she said. “And any time HR can get the attention of their senior leaders around the value proposition for investing in employee health and well-being, it’s a good thing.” w o r k f o r c e . c o m | Workƒorce
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FOR YOUR BENEFIT
More Than Zero: 401(k)s Will Feel Fed’s Rate Hike By Patty Kujawa
T
he economy is getting better, and so after seven years of near zero percent interest rates, the U.S. Federal Reserve raised its benchmark rate by 0.25 percent in December 2015. While it was a small move, the Fed promised more to come, and that can make a difference with 401(k) retirement plan account balances over time. “It’s a long-awaited signal from the Fed that the economy has achieved a certain milestone,” said Alan Glickstein, a senior retirement consultant at Willis Towers Watson.“We’ve been in a period of abnormally low rates.” For human resources professionals, the interest rate hike might alert some employees wanting to know what that means for their organization’s retirement accounts. Historically, higher interest rates mean better returns on money market and other savings vehicles.That is good news for people near retirement who can expect to make just a little bit more in these conservative savings accounts. For stocks and bonds, the interest rate increase could mean a more volatile market in the short term, while companies adjust to the new environment. For workers looking to take money out of their 401(k) account, a rise in interest rates means they will be paying more for the loan. Reducing the amount in the account can be a setback to a worker’s retirement savings schedule, but it does help that they are actually paying themselves back with higher interest going into the account. “Loans are a problem because they dampen long-term invest-
“Make sure your investment lineup meets the needs of all kinds of investors but is structured to handle the changing dynamics of the market,”Walsh said. Younger workers can stomach higher risk because they have more time in the market, but older workers nearing retirement need investments that can help protect what they have in their accounts. “People aged 60 to 65 don’t have time to mitigate volatility,” Walsh said. “Employees need access to investments to meet the needs in their particular life cycle.” Ready said that even though the interest rate hike was small, HR professionals should consider looking at their 401(k) plan investment options from four types of savers: Young workers, midcareer, near retirement and retirement. Looking at investment options this way can help identify gaps or possibly redundancies in the investment lineup that need to be addressed, he added. “The rising interest rate will spark the employee to ask ‘What do I do?’ ” Ready said. “These four savers have very different needs as it relates to retirement plans.” It isn’t enough to have a wide array of options, Walsh said. Access to education and advice is just as important. Communication, especially in times of changing market dynamics, is key. A 2015 TIAA-CREF survey showed that about a third of participants are not familiar with investment options available in their plan. More plan sponsors are offering investment advice, according to Callan Associates’ 2016 Defined Contribution Trends survey. The January survey of 144 plan sponsors showed 88 percent offered investment advice in 2015 compared with 79 percent the previous year. “Most participants don’t have the investment knowledge to make specific investment decisions,” he said. “There is a fear to doing this, and [HR professionals] need to show employees there is help available.”
‘PEOPLE AGED 60 TO 65 DON’T HAVE TIME TO MITIGATE VOLATILITY.’ —TIM WALSH, TIAA-CREF ment accumulation, even though you pay yourself back,” said Joe Ready, executive vice president of Wells Fargo Institutional Retirement and Trust. In the meanwhile, HR professionals can do a lot to help employees through what they might see as a worrisome situation for their 401(k) accounts, according to experts. In times of changing interest rates, it is important to offer multiple investment options to meet all employees’ individual needs, said Tim Walsh, managing director for investment services at TIAA-CREF. 18
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Benefits Beat
FACING THE REALITIES OF HDHPS By Rita Pyrillis
B
ack in 2010 when few employees had heard of high-deductible health plans, I met with an HR rep at my new job to discuss health plan options. In the past, I took a “whatever” approach to choosing benefits, but that’s when I was young and in peak health and had only me to worry about. Now with a family and several hospital visits behind me, choosing the right medical plan seemed like a much bigger deal. The human resources person handed me the enrollment materials and explained my various options, which included an HDHP. “What’s that?” I asked her, wondering why anyone would choose a plan touting a high deductible. She sighed. “If you pick that one, I’ll have to give you a number to call.” I asked her why. “I don’t fully understand it and we want to make sure that employees know how this plan works, so I’ll have to refer you to someone else.”
AS HDHPS BECOME MORE COMMONPLACE, I WONDER IF EMPLOYEES ARE PREPARED FOR THE DOWNSIDES. Aside from the hassle of calling a special number to hear an explanation, I didn’t think a plan with high out-ofpocket costs was the way to go given my situation, so I picked a PPO. But that was six long years ago. How times have changed. Since then, the popularity of HDHPs has soared with a growing number of employers offering them as the only plan option. Most HR pros and benefits managers have a firm grasp of HDHPs, and you probably won’t be met with a blank stare and a referral to an 800 number either. In 2009, 8 percent of workers were enrolled in an HDHP compared with 24 percent in 2015, according to a survey by the Kaiser Family Foundation, which defines HDHPs as plans with deductibles of at least $1,000 for single coverage and $2,000 for family coverage. They are typically paired with a tax-protected savings account to help employees meet their deductible. The appeal for employers is clear: Studies show that substantial cost savings can be realized when employees pay a 20
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greater share of their health care costs and become more prudent consumers. But as these plans become more commonplace, I wonder if employees are prepared for the downsides. Employers often talk about empowering workers to take charge of their health care, which sounds great until you’re hit with a $2,000 medical bill that you must pay upfront. I’ve been writing about this trend for a couple of years now and have interviewed a good number of benefits consultants and HR professionals, but few talk about the possibility that the HDHP trend could backfire. With deductibles rising faster than wages and more Americans saddled with medical debt, it’s a realistic consequence. Annual out-of-pocket costs per employee rose 230 percent between 2006 and 2015, according to Kaiser, and many employees enrolled in HDHPs report forgoing or delaying care as a result. A 2014 Gallup poll found that among those with insurance, 34 percent indicated that the cost of seeking care led them to put off seeing a provider. That number is up from 25 percent in 2013. A recent poll conducted by The New York Times and Kaiser found that about 20 percent of people under age 65 with health insurance reported having problems paying their medical bills over the past year.This led 63 percent of them to use up all or most of their savings, and 42 percent to take on an extra job or work more hours. Employees saddled with medical debt are not likely to bring their best game to work, and employees who avoid seeking medical care because they can’t pay their deductible will likely result in higher health care costs down the road as chronic conditions become serious health problems. Employers can’t afford to ignore or sugarcoat these realities. Those that do are doing themselves and their employees a disservice. But there are things employers can do to prevent this, like fully covering preventive care with no deductible, contributing to employees’ HSAs and paying the monthly fees, and providing training to employees who enroll in an HDHP so that they fully understand what they’re getting into. No one wants to get blindsided by a medical or prescription drug bill. If HDHPs are the future of employee benefits, employees will not be the only ones facing greater responsibilities; employers will be, too. Though the days of a blank look and 800 numbers are hopefully a thing of the past, they still must make sure that their workers are prepared for the realities that lie ahead. Rita Pyrillis is a former Workforce senior editor. She is currently a freelance writer based in the Chicago area. To comment, email editors@workforce.com.
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a d v e r t i s e m e n t
BEST PRACTICES IN HR WELLNESS
5 Ways Legal Plans Address Employee Wellness BY HYATT LEGAL PLANS
As employee wellness programs continue to grow in popularity, organizations are looking for ways to address all aspects of wellness, including financial and emotional health. According to MetLife’s 13th Annual U.S. Employee Benefit Trends Study (EBTS), 49% of employees experiencing financial stress are looking to their employer for help achieving financial security through benefits.1 Research conducted by Harris Poll on behalf of Hyatt Legal Plans2, found that many Americans would be interested in legal plans as a way to help them save money and worry less. Here are five ways a legal plan can help with employees improve their financial and emotional health:
1
Saves Employees Money According to Harris Poll, one of the biggest concerns of working adults is the cost of using an attorney. Over half, 59%, said they are concerned about paying for a good attorney. Considering that the average rate for an attorney is $290 per hour3, paying for an attorney is an expense that is out of reach for many Americans. On average, group legal plan members pay less than $240 a year for unlimited use of the legal plan for covered matters, which is significantly less than the cost of seeing an attorney just once for most legal matters. The survey found that a majority of employed adults, 62%, agree that having a legal plan would save them money if they ever needed legal services.
2
Provides Easy Access to Attorneys Another top concern of working adults is finding a good attorney. For many Americans, contacting an attorney is one of the most stressful things they encounter in their day-to-day lives. By providing access to qualified and prevetted attorneys, legal plans are designed to make it easy for individuals to find attorneys they can trust. The survey found near universal satisfaction with the legal plan among those enrolled in one. Ninety percent or more of those enrolled in a legal plan expressed satisfaction with their legal plan overall (93%), the quality of attorneys (91%) and the coverage provided (90%). Also, over 80% said that it is easy to access services and said they felt they
had a successful outcome from using the legal plan.
3
Allows Them to Prepare for the Future Harris Poll also found a need for legal services among nearly all employed adults. Many said they did not have two of the most important estate planning documents everyone should have – a will and a power of attorney. Only 42% had a will, 24% had a medical power of attorney and 20% had a financial power of attorney. Over half (52%) had none of these documents. A legal plan gives members access to attorneys who can
a d v e r t i s e m e n t
BEST PRACTICES IN HR WELLNESS
draft all of the legal documents they need, allowing them to protect their assets and their family.
4
Provides Stress Relief Because legal services can be so expensive, many Americans attempt to handle legal issues on their own. Without an attorney to handle the complicated paperwork and “legalese,” many people take on considerably more stress dealing with the issue than if they had competent legal representation from the start. And this stress can carry over from their personal life into the workplace, affecting their performance at work. According to the MetLife EBTS, 46% of employees who are financially stressed agree that they are less productive at work because of financial worries.4
Group legal plan members have access to attorneys that can draft and review legal documents for them and in many cases, attend hearings or make court appearances for them so they don’t have to miss work to deal with the issue. A voluntary benefit such as a group legal plan, which addresses a wide range of issues for employees of all ages, can help employers achieve their employee wellness goals.
73% of those who are enrolled in a legal plan say they are prepared for unforeseen legal events and 82% of those enrolled in a legal plan worry less about unexpected financial issues.
According to Harris Poll, 73% of those who are enrolled in a legal plan said that they are prepared for unforeseen legal events and 82% of those enrolled in a legal plan through an employer agreed that they worry less about unexpected financial issues because of their employer benefits.
5
Less Unexpected Time Away from Work The survey found that employees of all ages have taken time off of work to deal with unexpected legal issues. Thirty one percent of those ages 21-34 years old had taken unexpected time off work during the last year to deal with a legal issue and 14% of adults ages 35-49 had taken time off of work for legal matters.
1
To learn more about how legal plans can improve employee wellness, download the Hyatt Legal Plans White Paper at www.legalplans.com/Tools-Resources/White-Papers/ Employee-Legal-Study.aspx. Ann McDonald is the Communications Manager for Hyatt Legal Plans, a MetLife company and the country’s largest provider of group legal plans. Hyatt Legal Plans helps American workers address important life issues through group legal plans. The company serves three million people at more than 2,000 organizations, including over 150 Fortune 500® companies. L0116453788[exp0317][All States][DC,PR]
MetLife’s 13th Annual U.S. Employee Benefit Trends Study, 2015
The Harris Poll study was conducted on behalf of Hyatt Legal Plans from May 22 – June 3, 2015 among a nationally representative sample of 2,003 full time employed adults (aged 21 and older) with an annual income below $250,000
2
3
Average hourly rate of $290.00/hour based on years of legal experience, National Law Journal and ALM Legal Intelligence, Survey of Law Firm Economics (2013).
4
MetLife’s 13th Annual U.S. Employee Benefit Trends Study, 2015
COMPANY PROFILE Hyatt Legal Plans, a MetLife subsidiary, helps Americans address important life issues through legal services plans. The company provides affordable access to the most commonly needed legal services to over 13 million Americans nationwide. MetLaw®, Hyatt’s model group legal plan, features a nationwide network of over 14,000 licensed attorneys and award-winning client service available by phone or online. To find out more visit, www.legalplans.com
Legal Navigating Employee Wellness Programs The legal landscape for wellness programs is evolving, but this primer will help guide you down the right path. By Nicole Baldwin
E
mployee wellness programs have become increasingly popular over the years. However, companies are hesitant to implement these programs because of lack of legal guidance and uncertainty about the return on investment of corporate wellness. Despite the unknowns, there are plenty of reasons to implement a corporate wellness program. In fact, there have been numerous accounts of the positive effect wellness programs have on employers largely reporting that the programs are delivering its intended benefit — improving health and reducing costs. While the exact numbers for a company’s return on investment will differ, statistics on the effectiveness of wellness programs are promising. According to a 2012 review of 62 studies published in the American Journal of Health Promotion, companies with wellness programs had an average reduction of 25 percent in costs related to sick leave, health plans, workers’ compensation and disability insurance. In a 2014 study by Harvard Business Review of 20 companies, those with wellness programs had less of an increase in annual health care costs (1 to 2 percent) compared with the national average (7 percent). Other reports also show that, for each dollar invested into a corporate wellness program, companies have seen returns of approximately $1.50 or more. While some employers focus on the bottom line (i.e., the financial impact of wellness programs), improved employee
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morale and loyalty should be considered as contributing factors. There are numerous ways to go about creating and implementing a wellness program. First, consider the various regulations pertaining to them. For example, in 2013, the U.S. Labor, Treasury and Health and Human Services departments set forth rules for
Race for Compliance
I
recently participated in the sixth annual Del Mar (California) Mud Run, a 5K produced by a San Diego sport and social club, which offers activities for corporations seeking to provide wellness opportunities to their employees through kickball tournaments, field days and a host of other sports events that employees can participate in with their co-workers. Before the run, I was not looking forward to getting dirty or running. However, after completing the run with my law firm’s team, I felt a sense of accomplishment and had fun, too. That is what corporate wellness is all about: inspiring employees to do things that contribute to their health, while reminding them it is fun to be active. —Nicole Baldwin
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2016
wellness programs in the final regulations of the Affordable Care Act. The regulations require wellness programs to be reasonably designed to promote health or prevent disease and describe two basic program types: participatory and health-contingent. Participatory programs are those that offer employees health-related benefits, with or without a reward tied to them, such as free gym memberships, paid entries for 5K runs or paid membership to a softball league. Health-contingent programs require participants to satisfy a standard related to a health factor to obtain a reward, and such programs are divided into two categories: activity-only and outcome-based. Activity-only programs require employees to participate in an activity to obtain such a reward. Outcome-based programs require employees to achieve a specific outcome to receive an incentive. There are several requirements health-contingent programs must meet to comply with the ACA, so it is important to consult these rules prior to implementing such a program. Employers also must provide reasonable accommodations to allow employees with disabilities to participate in wellness programs. They should be mindful of additional rules set forth in the Americans with Disabilities Act of 1990; the Health Insurance Portability and Accountability Act of 1996; the Consolidated Omnibus Budget Reconciliation Act, better known as COBRA; the Employee Retirement Income Security Act, better known as ERISA; the Genetic Information Nondiscrimination Act, better known as GINA; and related state laws. Additionally, the U.S. Equal Employment Opportunity Commission proposed rules in April 2015, which, if enacted, would provide further regulation with regard to issues such as disability-related inquiries and medical examinations. Specifically, the EEOC seeks to clarify how wellness programs are affected by the ADA. While the legal landscape of corporate wellness programs continues to evolve, employers should remain optimistic given the positive reports thus far, and seek legal counsel for guidance on compliance issues. Based on my own experience, incorporating wellness into the workplace can be both fun for employees and rewarding for employers mindful of the bottom line. Nicole Baldwin is an attorney specializing in labor and employment issues for Carothers DiSante & Freudenberger in San Diego. To comment, email editors@workforce.com.
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Legal Legal Briefings RULING KEEPS JUST BETWEEN US TRULY HUSH-HUSH A properly drafted nondisclosure agreement can be crucial to protecting information. It can also potentially allow you to prevent an employee from disclosing information that would not qualify as a trade secret. In the recent Orthofix Inc. v. Hunter case, the 6th Circuit found that Eric Hunter, a former Orthofix employee, had violated a nondisclosure agreement when he disclosed nontrade secret information. Hunter worked as a medical-device salesman for Orthofix. In that capacity, he learned detailed information regarding schedules, preferences, prescribing practices and other aspects of Orthofix’s clientele. Hunter left the company to work at a competitor and used the information he learned to divert business to his new employer. Orthofix sued Hunter, claiming, among other things, he had breached his nondisclosure agreement. The trial court found for Hunter. It held that Orthofix had not established that the alleged confidential information qualified as a trade secret. The 6th Circuit reversed, noting that while the information used by Hunter might not qualify as a trade secret, it could still qualify as confidential. Finding that Hunter had made use of confidential information as defined by the employment agreement, the 6th Circuit ruled in favor of Orthofix. Orthofix Inc. v. Hunter, Case No. 15-3216 (Nov. 17, 2015). IMPACT: While this case was an interpretation of Texas law, employers that use nondisclosure clauses should ensure that they are obtaining the maximum protection possible for potentially confidential information.
‘ROLE’ PLAYING AND PROTECTED ACTIVITY Most employers know that an employee making complaints related to alleged Fair Labor Standards Act violations has engaged in protected activity. The situation gets complicated when it is not clear if an employee has actually made a protected complaint. Historically, courts have required a manager to “step outside his or her role of representing the company and either file (or threaten to file) an action adverse to the employer, actively assist other employees in asserting FLSA rights, or otherwise engage in activities that reasonably could be perceived as directed toward the assertion of rights protected by the FLSA” before they earned the protection against retaliation. The 9th Circuit Court of Appeals found that a managerial employee can engage in protected activity without “stepping outside her role” or taking “action adverse to the employer.” In Rosenfield v. GlobalTranz Enterprises Inc., the court determined that a company’s head of human resources making internal complaints still qualified as protected activity even though she had not explicitly taken a position adverse to her employer. Applying the “fair notice” standard the U.S. Supreme Court adopted in Kasten v. Saint-Gobain Performance Plastics Corp., the 9th Circuit found that GlobalTranz had received fair notice that its head of HR was engaging in protected activity. Alla Rosenfield v. GlobalTranz Enterprises, et al., case No. 13-15292 (Dec. 14, 2015). IMPACT: Following Rosenfield’s interpretation of Kasten, employers must be even more cautious in dealing with reports of possible FLSA violations. Mark T. Kobata and Marty Denis are partners at the law firm Barlow, Kobata and Denis, which has offices in Beverly Hills, California, and Chicago. To comment, email editors@workforce.com.
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Legal
Protecting Yourself From the Pain Jon Hyman |
The Practical Employer
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ife can be a pain, literally.We all deal with everyday aches. doctor’s note or taken under the FMLA. But, what happens when those aches and pains become Before December 2011, Lyerly had accumulated nine chronic, and, worse, begin to substantially limit one or more attendance points, and Southwest warned her in writing of an employee’s major life activities? Did I hear you gasp, that she was approaching her limit. In December 2011, Ly“ADA reasonable accommodation …?” erly accrued 12 additional points after missing six days of What kinds of aches and pains am I talking about? Ail- work for mental-health problems for which she had not ments such as migraine headaches, arthritis, back pain, carpal submitted a doctor’s note or requested medical leave. On tunnel syndrome and depression. Jan. 4, 2012, Lyerly entered a rehabilitation clinic and subWhat types of accommodations should you consider for mitted a medical-leave request dated back 17 days to Dec. these ailments? Let’s look at each, understanding that they 18, 2011. On Jan. 4, 2012, Southwest placed Lyerly on are just suggestions, and that each employee’s specific rea- company nonretroactive medical leave. sonable accommodation On Feb. 17, 2012, Southmust be tailored to that emwest terminated Lyerly upon ployee to enable him or her her return to work. Lyerly’s to perform the essential union and Southwest, howfunctions of the specific job. ever, agreed to reinstate her The only way to accomwith an agreed-upon 12 atplish this goal is to engage tendance points. in an interactive process When Lyerly took addiwith the employee. tional leave seven months • Migraines: Flexible leave; telecommuting; dark, private later, but did not return the required leave paperwork, rest area; different lighting; and noise-canceling headsets. Southwest terminated her employment. • Arthritis: Periodic work breaks; scooter or other Based on those facts, the district court had little problem mobility aid; ergonomic workstation or controls; al- dismissing Lyerly’s disability-discrimination claims. ternative computer or telephone access; arm supLyerly was neither a victim of discrimination nor interferports; writing and grip aids; and accessible routes, ence. She had been treated more than fairly. She had always ingress and egress. been given the leave she requested. She was reinstated after • Back pain: Work breaks; reduce or eliminate physical her initial firing. In the end, Lyerly failed to comply with a exertion; modified work-site; closer parking space; acces- neutral attendance policy — a situation that she admittedly sible bathrooms and work areas; and lifting restrictions. could have avoided. She will take nothing from Southwest. • Carpal tunnel syndrome: Periodic rest breaks; erEmployers should be self-motivated to accommodate ill gonomic workstations; arm supports, writing and grip employees. It’s not only the legal thing to do and the right aids, note-taking assistant; and carts and lifting devices. thing to do, but also a history of accommodations with an • Depression: Flexible work schedules or break sched- employee will serve as your best defense to deflect a subseules; reduced workload or tasks; job coach or mentor; quent discrimination claim by that employee. and access to an employee assistance program. Requests for accommodations are not the demarcation Lyerly v. Southwest Airlines Co. provides a textbook exam- on a battleground. Instead, they are a call for a middle ground. ple of why we accommodate employees. This employer Employers need to recognize this truth and avoid startbent over backward to accommodate an ill employee, and, ing wars that are not worth fighting. Legalities aside, howas a result, had little difficulty in defeating her subsequent ever, the issue of reasonable accommodations asks a larger disability-discrimination lawsuit. question: What kind of employer do you want to be? Do Lisa Lyerly worked as a flight attendant for Southwest you want to be a company that promotes tolerance or fosfor more than 17 years. During her tenure she used the ters exclusion? Family and Medical Leave Act for various medical condiThe former will help create the type of environment tions, including depression, peripheral neuropathy, diabetes that not only mitigates against religious discrimination, but and addiction, each without any adverse consequences to also spills over into the type of behavior that helps prevent her employment. unlawful harassment and other liability issues. Southwest’s employment policy assesses “points” for attendance violations. After an employee accumulates Jon Hyman is a partner at Meyers, Roman, Friedberg & Lewis in 12 points, a committee can approve a worker’s termination. Cleveland. To comment, email editors@workforce.com. Follow Employees do not accrue points for absences excused by a Hyman’s blog at Workforce.com/PracticalEmployer.
What kind of employer do you want to be? Do you want to be a company that promotes tolerance or fosters exclusion?
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ROAD TRIP! Road-tested HR innovations. New directions from people-management pros. Career-advancing networking. The all-new 2016 Workforce Live traveling series is scheduled for three stops this spring. Come along for the ride, and pick up a lot of fresh ideas on driving talent management forward.
April 14
April 19
April 28
BOSTON
NEW YORK
WASHINGTON, D.C.
Westin Copley Place 7 a.m. - Noon ET
Westin New York at Times Square 7 a.m. - Noon ET
The Willard InterContinental 7 a.m. - Noon ET
Speaker lists for each city and registration details at
events.workforce.com/live
Anatomy of the
WORKPLACE Focus on Health
W
ork can be a pain. Literally. It’s estimated that 38 million Americans each year suffer from migraines, while an additional 40 million employees currently struggle with crippling arthritis. And a recent study found that almost 10 percent of all workers’ compensation claims are related to back pain. Unfortunately, the way the workplace is configured can often exacerbate these issues and cause employees to have to manage their pain at work. Many employers are unaware of their employees’ struggles until they look at the bottom line.The World Health Organization estimates that presenteeism — when employees are physically at work but because of a physical or emotional issue are distracted to the point of reduced productivity — costs U.S. employers an estimated $150 billion a year. Despite the financial impact from pain, most employers are focused on addressing more visible diseases such as hypertension, diabetes and heart disease. Throughout this feature, we’ve included expert While the intenadvice from a group of physicians who treat the tion is pure, emphysical issues that working in offices can cause and ployers continue to exacerbate. Meet the experts. search for more effective — and inexDr. Paul K. Anderson, gastroenterologist, pensive — ways to Baylor University Hospital, Dallas help employees put in a pain-free day of work. Dr. Cameron Atkinson, hand surgeon, —Sarah Sipek Baylor University Hospital, Dallas
Guidance on Ailments
Dr. Gary Heiting, senior editor, All About Vision, Minneapolis Dr. Noah Rosen, neurologist, North Shore LIJ, Manhasset, New York Dr. David Zich, internist, Northwestern Medicine, Chicago
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ON THE WEB To watch Sarah Sipek’s interview with Canterbury CEO Liz Griggs on opioid abuse, visit: Workforce.com/Opioids
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YO ACHING Treatment for back pain, especially surgery, can be expensive and might not produce exceptional results. Some employers have decided to be proactive about reducing back pain to help workers cope — and save money in the process. 30
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UR BACKS BY CHARLOTTE HUFF
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efore the 400-plus employees at a General Dynamics Corp. plant in northern Florida start their shift each day, they perform five minutes of targeted movements — sometimes in groups and sometimes individually — specifically designed to protect the joints that are so crucial on and off the job. The employees also are asked to pause momentarily throughout the day to repeat some of those movements, especially stretching out the lower back, said Judy Harris, an occupational health nurse practitioner at the
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A rthritis Symptoms: Intermittent or sharp pain in the ankles, back, fingers, hands, heels, joints, muscles, neck or wrists Diagnosis: There are two major types of arthritis: osteoarthritis and rheumatoid arthritis. Osteoarthritis involves wear-and-tear damage to your joint’s cartilage — the hard, slick coating on the ends of bones. Enough damage can result in bone grinding directly on bone, which causes pain and restricted movement. This wear and tear can occur over many years, or it can occur faster after a joint injury or infection. With rheumatoid arthritis, the body’s immune system attacks the lining of the joint capsule, a tough membrane that encloses all the joint parts. This lining, known as the synovial membrane, becomes inflamed and swollen. The disease process can eventually destroy cartilage and bone within the joint. Doctor’s Orders: Aside from prescription or over-thecounter medications, walk around every 20 to 30 minutes to alleviate the joint stress of sitting. In addition, employees should focus on keeping their feet flat on the floor to keep pressure evenly distributed, said Dr. David Zich, an internist and emergency medicine physician at Northwestern Medicine in Chicago. Employer Action: For employees who spend the day sitting at desks, the right chair and the right positioning can make a world of difference. “Also, find a chair that fits,” Zich said. “If you can get one with lumbar support, that’s best. If not, provide a small pillow or a tightly rolled up towel to place between the small of an employee’s back and the back of the chair.” Not sure if your chair fits? Zich recommends using the “1-inch rule.” When sitting back, there should be at least a 1-inch gap between the edge of the seat and the backs of your knees, and the seat of the chair should be at least 1-inch wider than your hips and thighs. The chair’s back should be wide enough for your back, but not too wide to restrict arm movements, such as reaching 90 degrees to your sides. —Sarah Sipek
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chemical manufacturing plant.“I want them to transfer this to their full lives,” she said, “and not just think that injuries occur on the job.” Companies like General Dynamics are building on medical evidence that shows relatively low-cost and lowtech measures can help ease back pain, which, according to one report, affects nearly 1 in 4 U.S. workers. Whether it’s promoting better body mechanics or physical therapy requirements before an imaging test, employers are striving to press the pause button on a rush to back surgery. “Once you’ve cut, you can’t go back — there’s no reset,” said Olivia Ross, associate director of the Pacific Business Group on Health. “In a situation where you’re not sure surgery will help, we really want them [employees] to exhaust all other conservative measures before we start the snowball.” As wellness programs have become common in the workplace over the past decade, employers are more attuned to the cost of back pain not just in workers’ compensation claims but also on the health claims side of the ledger as strains accumulate, said Chuck Smithers, interim CEO of the National Business Coalition on Health. “You step off the ladder the wrong way over the weekend and then you get into the office, and all of a sudden the chairs aren’t very ergonomic and so it ends up exacerbating the problem.” The goal of these various back initiatives, proponents say, is to short-circuit what some describe as a cascading effect, in which employees get pricey imaging tests that highlight a back issue that might or might not be causing their pain and thus are referred to surgery. Last April, the Pacific Business Group on Health added a spine initiative to its Centers of Excellence program, in which participating employers pay for both workers’ travel and medical costs to encourage them to pursue a multifaceted spine evaluation at a designated facility. “One of the things that has been most interesting for me, from talking to our surgeons, is how many cases they see where someone is coming in for the second or third procedure because the first one never should have been done,” said Ross, who oversees the Centers of Excellence program. Fostering better joint mobility at the General Dynamics plant, which officials implemented after contracting with Tallahassee, Florida-based Integrated Mechanical Care Inc. in 2011, has already paid off on the workers’ compensation side, according to data Harris provided. The plant, which spent $6,555 on lumbar claims in 2013 and an additional march
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E yestrain /C omputer V ision S yndrome $5,814 in 2014, paid out just $370 during the first six months of 2015.
Evidence vs. Practice An analysis by the San Francisco-based Integrated Benefits Institute revealed that almost 25 percent of workers report experiencing lower back pain, a problem that ends up costing employers $51,400 annually per 100 employees in lost productivity and medical treatments.Yet data show that despite clinical guidelines stressing the importance of less-aggressive interventions such as physical therapy, it hasn’t made a significant dent in practice. From 1999 through 2010, the percentage of patients sent for physical therapy remained unchanged at 20 percent
Symptoms: Dry, red, tired eyes resulting from hours spent in front of a computer screen are a common complaint among employees. According to the American Optometric Association, anywhere from 64 to 90 percent of office workers suffer from a condition known as computer vision syndrome. While it won’t cause permanent damage, the headache, blurred vision and neck and shoulder pain associated with the condition can be distracting to employees.
‘ONE OF THE THINGS THAT HAS BEEN MOST INTERESTING FOR ME, FROM TALKING TO OUR SURGEONS, IS HOW MANY CASES THEY SEE WHERE SOMEONE IS COMING IN FOR THE SECOND OR THIRD PROCEDURE BECAUSE THE FIRST ONE NEVER SHOULD HAVE BEEN DONE.’
Diagnosis: “The eyes have a tendency to lock up after a person stares at a computer screen for too long,” said Dr. Gary Heiting, a Minneapolis-based ophthalmic surgeon. “It’s called an accommodative spasm.”
—OLIVIA ROSS, PACIFIC BUSINESS GROUP ON HEALTH
“When you’re using a computer, the ambient lighting in the background should be about half as bright as that typically found in most offices,” Heiting said. “Start by closing the blinds to eliminate exterior light. From there you can use fewer fluorescent tubes or invest in lower intensity bulbs. In terms of office layout, try and position computer screens so that there are no windows directly in front of or behind a computer screen.”
while referrals to other physicians increased from just under 7 percent to 14 percent, according to a 2013 study in the journal Spine. The use of narcotics also increased. They were prescribed for 19 percent of back pain cases in 1999 vs. 29 percent in 2010.The costly images like CT scans and MRIs also increased. They were ordered in 7 percent of cases in 1999 vs. 11 percent a dozen years later. Some surgeries, such as repairing a herniated disc in an active worker, can potentially offer relief, said Dr. Richard Deyo, a lower-back-pain researcher based at Oregon march
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Doctor’s Orders: “Blink more often,” Heiting said. “It’s not realistic to focus on blinking every minute of the day, but stopping every 20 minutes to open and close your eyes slowly 10 times will re-wet the eye and keep it moistened.” Employers can also instruct employees to look far away at an object for 10 to 15 seconds, then gaze at something up close for 10 to 15 seconds, then look back at the distant object. Employer Action: High prevalence rates suggest that employers should take the lead and create a workplace that doesn’t trigger computer vision syndrome, Heiting said.
There are also other obvious solutions, such as dimming screen brightness and increasing text size so as not to increase eyestrain. —Sarah Sipek w o r k f o r c e . c o m | Workƒorce
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I nsomnia Symptoms: Difficulty falling asleep, frequent awakening, not feeling well-rested after sleeping, daytime tiredness and irritability, depression or anxiety, difficulty focusing and indigestion. Diagnosis: Work stress is a common cause of insomnia. Deadlines and other daily demands can keep the mind active at night, which makes it difficult to get a restful night’s sleep. In addition, travel and prolonged periods of coming in early or working late can disrupt your circadian rhythms — the body’s internal clock that regulates the sleep-wake cycle, metabolism and body temperature. Doctor’s Orders: When it comes to dealing with tired employees, education is the best intervention, according to Dr. David Zich, an internist and emergency medicine physician at Northwestern Medicine in Chicago. “Most people have bad sleeping habits,” Zich said. “Making employees aware of what they’re probably doing wrong and offering solutions to fix it can have a measurable impact on their alertness at work.” Step 1: Get the screens out of the bedroom. The light emitted from TVs and the like suppresses a body’s production of melatonin and can severely disrupt sleep, Zich said. Step 2: Cut out the caffeine. Drinking caffeinated beverages late in the day can prevent an employee from getting to sleep at a normal time, Zich said, and can lead to fatigue. Employer Action: Wellness programs can also play a significant role in helping employees battle insomnia. A 2010 study conducted by the National Sleep Foundation found that moderate-intensity aerobic workouts, such as walking, reduced the average time it took a person to fall asleep. Zich recommends offering a combination of gym access and yoga classes. “Progressive muscle relaxation is practiced in restorative yoga positions and can help employees reduce anxiety and get to sleep at night,” he said. Also, track employees’ stress levels, Zich said. Stress is a leading cause of insomnia. Any steps an employer can take to monitor workload and anticipate warning signs of overwork will help minimize employees’ insomnia.
Health & Science University in Portland. But other surgeries, most notably spinal fusions for back pain alone (without any nerve pain down the leg, called sciatica), continue to increase. Those fusions are “the most controversial because we have clinical trials suggesting that the surgery may not result in much better results than rehabilitation alone,” Deyo said. A 2012 study in the journal Spine found that the number of spinal fusions had more than doubled, increasing 137 percent from 1998 to 2008. Back operations are driven in part by vivid imaging tests like MRIs, Deyo said. By the age of 50, nearly everyone will have some evidence of a bulging or degenerated disc or other sort of spinal abnormality, he said. “The
READER REACTION
What’s the top health issue employees deal with in your workplace? @ApresGroup : It’s got to be musculoskeletal issues: bad backs, posture etc. That’s why we recommend #sitstand desks! #getbritainstanding
@hfit: Expansion of wellness to include multiple dimensions of well-being and ensuring we’re addressing these dimensions in outreach
@taisimone: Stress! But it could be from dealing with parents with dementia or aging issues.
@ergomorphis: When I worked in a call center for nearly 10 years, the main concern was and is the sitting disease.
@Tyreekappa: Obesity is the top issue among staff.
Join the discussion at tinyurl.com/TopHealthIssue or follow us on Twitter @Workforcenews.
—Sarah Sipek
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I rritable B owel S yndrome problem there is once you see these things, both the doctor and the patient may be alarmed and feel like they have to do something, even though that may not be the cause of the pain,” he said.
Preventing the Cascade The Pacific Business Group on Health’s addition of the spinal initiative is an attempt to head off that procedural snowball effect, joining the Centers of Excellence’s programs targeting cost-effective care for hip and knee replacements. JetBlue Airways Corp., Lowe’s Companies Inc. and WalMart Stores Inc. were the first employers to sign up, and Ross anticipates that as many as a half-dozen employers will join the spine program by 2017. They are working with several designated hospitals to refer employees and dependents — typically those who have already been recommended for back surgery — to travel to the facility for a full work-up and discussion of related options with a physical therapist, a surgeon and other clinicians, Ross said. It’s a voluntary program, but there are some built-in incentives, said Bob Ihrie, Lowe’s senior vice president of compensation and benefits. Participants don’t have a copay or deductible for the medical consults at the facility and related treatment, including surgery if recommended, as well as the travel costs for themselves and a companion, he said. “Many employees who maybe couldn’t afford the surgery under our regular medical plan might choose to go to the Center of Excellence and they have minimal or no costs,” said Ihrie, who said any costs would be confined to follow-up such as post-surgery rehabilitation closer to home. Based on Lowe’s first year of joint replacement data from 2014, the evaluation does reduce the likelihood of surgery, according to data Ihrie provided. Of the 231 cases referred to a Centers of Excellence facility, 15 percent were not deemed a surgical candidate. Of those, 92 percent still hadn’t gone through with the surgery six months later, said Ihrie, who anticipates that the back nonsurgery rates will be similar if not higher given research data on overuse. “People want to say it’s a cost play,” Ihrie said. “For us it’s more of a quality play, really, a quality of life for our employees.” It’s too early to detail any results for the Pacific Business Group’s spine initiative, but in the first seven months through Oct. 31, 2015, nearly 300 employees or dependents called the Centers of Excellence program for more march
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Symptoms: Cramping, abdominal pain, bloating, gas, diarrhea and constipation. Diagnosis: According to the International Foundation for Functional Gastrointestinal Disorders, irritable bowel syndrome, or IBS, affects 10 to 15 percent of the adult population in the United States. IBS is a common disorder that affects the large intestine. The walls of the intestines are lined with layers of muscle that contract and relax to move food from your stomach to your small intestine. The contractions may be stronger and last longer than normal or the opposite may occur, with weak intestinal contractions slowing food passage. It is a chronic condition that requires long-term management. Doctor’s Orders: IBS can be an embarrassing condition to deal with in the workplace, but it’s important for sufferers to know that they’re not alone. While there is no cure, there are ways employers can help their employees manage the abdominal pain and discomfort that characterize IBS, said Dr. Paul Anderson, a gastroenterologist at Baylor University Medical Center in Dallas. Those suffering from IBS should avoid dairy products, Anderson said. Employer Action: “Employees don’t like to talk about their digestive issues at work,” Anderson said. “Bring it up gently. Many worksite wellness programs have a healthy eating component. Fiber can help IBS symptoms. It’s [fiber] also good to consume in general. So when offering healthy eating tips, mention fiber as a solution to IBS.” Pamphlets and materials put together to educate employees can contain a line warning about the impact of these types of foods on employees with digestive issues. —Sarah Sipek w o r k f o r c e . c o m | Workƒorce
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M igraines Symptoms: Nearly half of all migraine sufferers go undiagnosed, which means employees are often left to deal with the head pain, dizziness, blurred vision and sensitivity to light and sound that characterize migraines without proper medical help. Diagnosis: Migraines affect 38 million Americans yearly, according to the Migraine Research Foundation. Unfortunately, the workplace contains many migraine triggers, such as bright lights, caffeine and general stress. Doctor’s Orders: Dr. Noah Rosen, director of the Headache Center at the Cushing Neuroscience Institute at the North Shore-LIJ Health System in Manhasset, New York, first suggests being proactive. Rosen recommends staying hydrated, limiting caffeine and salty foods, and taking small breaks from sitting at a desk to prevent and alleviate symptoms. “Employees should keep any non-narcotic pain relievers at their desk,” Rosen said. Narcotic-based pain medicines “often contain strong sedatives, which can be dangerous if an employee works with heavy machinery. It also doesn’t help in terms of an employee’s productivity levels.” Employer Action: Employers can take a proactive stance by installing anti-glare screens and avoid the use of fluorescent lighting whenever possible, Rosen said. “Something else many employers don’t realize is that ergonomics plays a big role in triggering migraines,” Rosen said. “Setting up a chair so that an employee isn’t looking down or up at a computer screen can reduce potential migraine triggers.” —Sarah Sipek
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information, Ross said. Of those, roughly half were referred to one of the designated facilities, which by late 2015 included Seattle’s Virginia Mason Medical Center, Mercy Hospital in Springfield, Missouri, and Geisinger Health System in Danville, Pennsylvania. By Oct. 31, 78 individuals had visited one of the hospitals for a surgical evaluation. (Some may plan to go but are still scheduling the trip, Ross added.) Of those, 28 underwent surgery, several had another procedure on-site such as an injection, and the remaining 46 were told that they wouldn’t benefit from an operation. “Every single one of those people was told in their home market that they needed to have surgery,” Ross said. Back surgery is expensive, with a spinal fusion of the lower back most typically costing $70,000 to $90,000, Ross said. “You can imagine if an employer even is paying for five or 10 of these [surgeries] a year that they shouldn’t be, it’s an enormous expense,” Ross said. And that’s before factoring in recovery time off the job and perhaps additional surgeries down the line, she said.
Movement Interventions The technique used by physical therapists and chiropractors at Integrated Mechanical Care builds upon a physical therapy approach called the McKenzie Method, which uses assessment and not imaging tests to determine whether pain can be eased through a series of movements to counter daily and often repetitive joint stressors. Today’s workplaces, for example, can inflict undue strain on the back, whether someone is working at a computer or on an assembly line, said Chad Gray, a physical therapist and the company’s president. “They are bent forward all day long, but never bend back in the opposite direction as far as they can go,” he said. “What’s going to happen over time is that they are going to gradually lose movement and become stiff.” One of the priorities of the company, which is working with nearly a dozen employers including General Dynamics and Michelin North America, is tracking employee outcomes. Integrated Mechanical Care’s data show that 9 out of 10 people with lower back pain can be treated, according to Gray. (The remaining 10 percent might have a psychological cause or another component that’s more difficult to resolve, he said.) Of those, 95 percent have some kind of mechanical cause, such as pressure on the nerve in the spine, that can be counteracted with recommended movements, he said. The remaining 5 percent of patients either suffer from an march
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S eizures inflammatory cause and might require an injection or likely needs surgery, he said. At Michelin North America, the company has brought Integrated Mechanical Care clinicians on-site to evaluate and assist employees with lower back pain or other musculoskeletal complaints at the company’s several on-site health centers and a few other worksites, said Jeni Marconi, worksite health and wellness manager for the Greenville, South Carolina, company. Along with diagnosing and preparing treatment plans, the clinicians also have assisted with on-site ergonomics, such as looking at ways that employees can interact with the equipment to better protect their joints, she said. The employees at General Dynamics continue to be diligent about performing their daily start-of-shift movements, with participation exceeding 95 percent, Harris said. In 2014 the plant did a reboot, bringing the employees back for an additional session of roughly half an hour “to explain the anatomy and physiology of why” the movements are helpful, Harris said. “The goal there was that, if you understood, then you would understand why we wanted you to do it more than once or twice a day,” she said, such as when an employee is lifting a fishing boat out of the water some Sunday. The Integrated Mechanical Care lumbar treatment approach has proven to be nearly 40 percent cheaper compared with traditional care, according to data from one company’s health claims presented last fall at the International Conference in Mechanical Diagnosis and Therapy. The average 12-month cost was $1,749 for the 165 employees with back pain who were treated by an Integrated Mechanical Care clinician — costs that included any follow-up surgery or procedures if needed — compared with $2,905 for the slightly more than 4,400 who got traditional care, according to Dr. Ron Donelson, a spine specialist and study co-author. The analysis incorporates health insurance claims only and doesn’t reflect related costs, such as workers’ compensation or disability, said Donelson, a proponent of nonsurgical care including the McKenzie approach. Those additional figures once collected, he said, hold the potential to “greatly increase the savings.” Mobility benefits that companies like General Dynamics and Lowe’s hope will pay off for employees on and off the job. Charlotte Huff is a writer based in Fort Worth, Texas. To comment, email editors@workforce.com.
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Symptoms: Rhythmic muscle contractions or spasms, amnesia or mental confusion, feeling of pins and needles in limbs, fainting or fatigue, depression or fear, headache and temporary paralysis. Diagnosis: A seizure occurs when there’s abnormal electrical activity in the brain. Seizures usually come on suddenly and vary in duration and severity. A seizure may be a onetime event, but some people have seizures repeatedly. Recurrent seizures are called epilepsy, or a seizure disorder. Less than 1 in 10 people who has a seizure develops epilepsy. Experts classify seizures into two general categories based on the pattern of attack. Generalized seizures involve both sides of the brain from the start of the attack. Partial seizures begin in a specific area and may be contained there. Or they might spread to the entire brain. Doctor’s Orders: Employees diagnosed with a seizure disorder, such as epilepsy, should take their medication regularly and keep it with them at all times, said Dr. David Zich, an internist and emergency medicine physician at Northwestern Medicine in Chicago. Employer Action: While it’s uncommon for workplace settings to trigger seizures, it’s important for employers to minimize the risk for those employees who may suffer from seizure disorders, Zich said. Bright, flickering light is a common trigger. Employers should try to reduce the amount of fluorescent lighting in an office setting and have bulbs replaced immediately when they begin to flicker. In addition, sleep deprivation is the most common way to induce a seizure. When educating employees on the potential dangers of sleep deprivation, risk of seizures should be brought up, Zich said. If an employee suffers a seizure at work, the main goal should be preventing that person from falling. “Guide the individual to the floor and don’t try to restrict movement,” Zich said. “As long as their airway is clear, the best thing you can do is give them space and call 911.” —Sarah Sipek w o r k f o r c e . c o m | Workƒorce
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Welcome to Wellness 2.0 BY RITA PYRILLIS
Companies are spending less time worrying about the elusive return on their wellness program investments and more on the well-being of their workforce.
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C
orporate wellness has evolved in fits and starts since the first executive gyms appeared after World War II. But despite continuing concerns regarding the effectiveness of employee wellness programs, the industry has exploded in recent years. Focusing efforts on the sickest workers and paying or punishing people to get healthy have become common practices, but some employers are taking a different approach and ditching financial incentives, embracing the importance of emotional
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health and redefining the concept of return on investment. The hard-dollar approach of measuring money spent on wellness efforts against health care dollars saved is giving way to a more nuanced view that values softer benefits like employee morale and company loyalty. And more employers are abandoning carrot-and-stick methods such as offering or withholding discounts on insurance premiums to get employees to participate. Instead, companies are creating environments designed to make wellness easy and fun. Even the term “wellness” is falling out of favor as more companies adopt a holistic approach that includes emotional and financial well-being, according to LuAnn Heinen, vice president at the National Business Group on Health, an employer advocacy group based in Washington, D.C. “We’re moving from wellness to well-being,” said Heinen, who heads up the group’s Institute on Innovation in Workforce Wellbeing. “In traditional wellness programs, we measure success by participation and ROI on medical costs, but in today’s approach it’s not about ROI. It’s about productivity, and business metrics, and retention, and customer satisfaction. It’s not about health and benefits in silos, but about broader well-being, and that includes social connectedness, financial security, emotional health and job satisfaction.The old way of getting everybody to do the same thing is being abandoned.”
Value of Investment The number of employers embracing this approach is growing rapidly, according to a 2015 survey by U.K.-based insurer Willis Group. Sixty-four percent of employers with wellness programs are more focused on “value of investment” compared with 28 percent who indicate that they are more focused on “return on investment,” the survey found. “More organizations are realizing that the expectation of an immediate return on investment (ROI) for their wellness programs through medical-cost reduction may be unlikely,” according to the survey. At Kimberly-Clark Corp., which launched its wellness program in 1975, health care costs are a top concern, but
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ROI doesn’t factor into the wellness program, said Stephanie Pereira da Silva, health and wellness manager who oversees the company’s wellness initiatives. “We don’t track it,” she said. “Companies can really manipulate those numbers in their favor.We look at participation rates and long-term behavior change. We have online medical records dating back to the ’70s, so we can see if a program is successful. Do we care about the numbers? Absolutely we do. We track health care costs, but it’s not tied to our wellness program.”
‘WE’RE MOVING FROM WELLNESS TO WELL-BEING.’ —LUANN HEINEN, NATIONAL BUSINESS GROUP ON HEALTH The Irving,Texas-based producer of personal care products also bucked the wellness incentives trend. That approach didn’t fit with the company’s philosophy that culture can be a greater influence on behavior than punishments and rewards, according to Pereira da Silva. “We take a more reserved approach to wellness,” she said. “When everybody jumped on the bandwagon of tying health insurance incentives to behaviors, reward and punishment, we didn’t jump. If you look at the trend over the years, companies are backing away from that approach. We are trying to create a culture of wellness.We don’t want to penalize you.” Kimberly-Clark, which has 43,000 employees in 37 countries, employs a cadre of health professionals and volunteers that operate its exercise facilities and wellness programs around the world, including a dozen occupational nurses. The focus on and fretting over the return on investment of wellness is misguided, said Michael Staufacker, director of health management at Emory University. “We look at things like reducing employee health risks, improving employee productivity, job satisfaction, business performance metrics,” he said. “Are we retaining and recruiting the employees we need? Are we improving employee morale? It’s not expected that we prove ROI for other benefits. We don’t expect the health plan or EAP to show ROI, so why should we expect it of wellness?” Instead, the university is focused on creating an environment that encourages employees to get healthy by making it convenient and fun, Staufacker said. It launched its wellness program, called Healthy Emory, in 2013. The university provides maps of campus art walks and green spaces to employees and students, it deploys employee volunteers to promote various wellness programs and events, hosts a weekly farmer’s market, offers discounts on bikes and Fitbit wearable fitness trackers, sponsors health challenges throughout the year, and provides healthy food in its cafeterias and vending machines, among other initiatives. march
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“When we developed Healthy Emory, we thought about how to positively influence behavior, and we identified several areas, like environment, culture, community and using the resources we have as a world-class health care system,” he said. “Traditional wellness programs that only focus on a small aspect of health and well-being probably have only a small positive influence on health and productivity.”
It’s About Health, Not Money Ann Mirabito, a Baylor University business professor, said the most effective wellness programs — ones that lower health care costs, increase productivity and improve morale — have certain traits in common. The best ones actively involve the CEO and other leaders, are in sync with the company’s mission and business goals, recognize the importance of emotional health and are fun, she said. “The ideology behind successful workplace wellness programs is that employees deserve to be healthy, not that this is a great way to save money for the company,” she said. She likens the most successful wellness programs to social movements, which grow from the ground up. “Wellness programs cannot be imposed from the top down because they won’t be accepted by the employees,” Mirabito said. “Successful programs are created by the employees. Organizations that have this culture have created social norms around healthy behaviors. They have worked hard to reduce barriers to wellness by making healthy food convenient and available, making it easy to exercise, to get flu shots or to take care of their chronic illnesses.” Punishing employees who fail to change their behavior is sure to fail, added Henry Albrecht, CEO of Limeade, a Bellevue, Washington-based company that offers an online platform that encourages employees to adopt healthy habits. “For the last 15 years, wellness was focused on singling out the weak and reducing health risk and cost,” he said. “That makes sense on paper, but it doesn’t make any sense from a behavioral science point-of-view. People don’t change because there is something wrong with them or by giving them lots of money. That’s only good for one-time tasks like screenings.” Limeade’s platform allows employees to create personalized health plans based on their location, job and health assessment data, among other factors, and to track their progress. Incentives are part of the program but are tied to march
2016
reaching various health goals. Employees can earn cash, gifts or paid time off. “Our philosophy has always been to find fun and simple technology-based ways to help employers get people to improve their health, not because they are expensive to insure but because they believe that an engaged, high-performing, high-morale workforce drives business,” Albrecht said. That is especially true among health care providers where burnout is high and stressed-out workers can affect patient care. At Cincinnati Children’s Hospital Medical Center, nearly 80 percent of its 15,000 employees are women, and the average age of its workforce is 39, which means a good number are caring for both children and parents, according to Rachael Grile, a human resources specialist who manages the hospital’s wellness programs. Not surprisingly, a large number of employees struggle with anxiety, depression and insomnia. So when the hospital began developing its wellness program in 2010, addressing those needs was a top concern. “Our population works with complicated and difficult situations involving children so we wanted to focus on the emotional aspect of health,” she said. “For our employees, work-life balance is a blur. What happens at work comes home and what happens at home comes to work.” The hospital partnered with Limeade to launch MyHealthPlan in 2011. Before then, there was no formal wellness program, “just a few lunch and learns and some fitness classes,” she said. Nearly 80 percent of the hospital’s workforce participates in MyHealthPlan, Grile said. While the program started with a focus on physical health, it evolved to include programs that address emotional needs, like stress management, financial health, career growth, and social and community connections. “We have a variety of different financial seminars on budgeting, raising money-smart kids, and we push employees to volunteer, to participate in the United Way or Paint the Town, which is an effort to beautify neighboring communiWELLNESS 2.0 continued on page 49 w o r k f o r c e . c o m | Workƒorce
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SPECIAL REPORT
Dental, Vision & Health Insurers
Small Bites: The Appeal of Dental and Vision Benefits
Dental and vision benefits are affordable and important in terms of keeping employees healthy. The challenge is to drive interest so more people use these benefits. By Sarah Sipek
I
n terms of worries, benefits managers face a familiar concern: cost-conscious employers and a workforce worried about paying more and getting less bang for their health care buck. According to its annual Employer Health Benefits Survey, the Kaiser Family Foundation and Health Research and Education Trust found that the typical employer contributed $12,591 to a family coverage plan in 2015. That figure represents a 54 percent increase from 2005, when the contribution was $8,167 per enrolled family. Employees haven’t gotten off much easier. The same study found that the average employee paid $4,955 out of pocket in 2015, up a whopping 83 percent from 2005 when the contribution was about $2,700. Costs are high; that’s no surprise. And employers are vocal about finding a solution. Many have turned to the idea of corporate wellness, said Bob Gevelinger, vice president of group field sales for Ameritas Life and Ameritas Life of New York. “It makes perfect sense,” Gevelinger said. “Employers want to keep employees healthy so they aren’t filing claims and driving up costs.” And while fitness bands and healthy snack options play their part, there are other less expensive benefits options that employers have at their disposals to help keep their employees well: dental and vision benefits. “The connection between oral and vision health and overall health is clear,” said Stu Shaw, vice president of group risk management for the Guardian Life Insurance Co. of America. “Providing access to quality, affordable dental and vision care can keep employees more healthy and produc-
tive, helping to control health costs.” According to Shaw, employees with dental and vision benefits are more likely to visit dentists and optometrists to receive regular treatment, which aids in the early detection of hypertension, high cholesterol, diabetes and even brain tumors — which typically require visits to specialists if the employee visits a doctor first. In addition, the typical stand-alone dental and vision plans are considered excepted benefits and are not subject to the 40 percent excise tax known as the “Cadillac” tax, which has been delayed until 2020. As a result, some employers are adding them to soften the blow to employees as they cut back on medical offerings to save costs, Shaw said. Benefits and HR consultancy Segal Group Inc.’s 2016 Health Plan Cost Trend Survey found that trends for dental coverage are expected to be lower for 2016 compared with 2015. Dental plans in particular are projected to decrease to 3.5 percent of an employer’s annual health care budget for fee-for-service plans and dental plan organizations. Vision costs are projected to remain the same — just 2.7 percent. While it makes good health and fiscal sense to offer these benefits, insurance companies have had to adjust to give both employers and employees what they want in terms of information and ease of access in order to ensure that dental and vision plans capable of driving down costs and keeping employees well are given the opportunity to do so. As employers’ health care costs have climbed, they have gotten savvier with their spending, Gevelinger said. Gone are the days where employers make benefits decisions “just because
STAND-ALONE DENTAL AND VISION PLANS ARE CONSIDERED EXCEPTED BENEFITS AND ARE NOT SUBJECT TO THE ‘CADILLAC’ TAX, WHICH HAS BEEN DELAYED UNTIL 2020.
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that’s what they’ve always done.” Now, employers want numbers to back every decision. “We’re more data-driven than ever before,” Gevelinger said. “Employers demand more information. They want to be able to spot trends within a group to determine exactly who is using the benefit.”
KEEPING SCORE Many employers want “score cards” from their providers. They work like baseball cards for a company’s benefits usage, Gevelinger said. Employers can break it down by department in terms of who is using what benefits and how often. “This helps them make plan decisions that cut the fat and offer only what employees demonstrate they need,” Gevelinger said. The desire only to buy plans their employees will use means that the plans themselves are changing. In the past, dental and vision plans were generic. Employers could choose to offer plans with 100, 80 or 50 percent coverage. Typically this included a $50 deductible with a $1,000 maximum benefit, explained Beth Bierbower, president of Humana’s employer group segment. “The demand for data means that employers are coming back to us and asking for higher annual maximums and smaller copays more consistent with what our typical medical offerings look like,” Bierbower said. In addition, paying closer attention to the makeup of a workforce means that employers want plans offering more frequent dental cleanings at 100 percent coverage for pregnant women and children, since dental exams are an early detector for gestational diabetes and early childhood diabetes, Bierbower said. In the case of Ameritas, employers have requested that any funds left over in a dental plan account be allowed to be used to purchase vision coverage if the employee chooses. “A more educated consumer means that we’ve been forced to change our plans or have employers look elsewhere for more flexible offerings,” Bierbower said.
TANTALIZING WITH TECHNOLOGY Last year Lukas Ruecker, the president of vision insurance provider EyeMed Vision Care, fell while climbing near a waterfall in India and lost his glasses. Even though he is the president of a vision company, it took three days before he was able to replace them. And he admitted he is “as blind as a bat.” In that moment of helplessness, he saw the challenges and a potential solution for a growing segment of the workforce: millennials. “Millennials make up the majority of the workforce today,” Ruecker said. “And that workforce is becoming increasingly international. My situation provided firsthand insight into what it would be like to try and navigate the vision benefits world in a different country in a language you do not speak.” That experience drove Ruecker to develop a mobile app march
2016
that not only provides access to temporary, next-day adjustable eyewear, but also a list of providers that sell authentic frames. The app also provides translation services in more than 160 languages to help during the appointment. In addition to this unique, international benefit, the app also stores insurance card information, prescription details and allows employee consumers to compare costs and reviews of in-network optometrists. “We wanted to use technology to better educate and inform the employee in a day and age where employers put so much of the onus for health care on their employees,” Ruecker said. “If an employee has to make a decision alone, we want to make sure that they have easy access to the information to get the best care possible.” Shaw said that as consumers become more astute health care purchasers, it’s important to ensure they have the most choice possible in their selection of dentists and greater control of out-of-pocket costs. “Better technology improves the speed and accuracy of that information in a way that will positively impact employee health,” he said.
BOTTOM-LINE VALUE: A HEALTHY WORKFORCE Bottom-line value is the concern of every employer, and while insurance companies can offer low costs for dental and vision plans, the impact of that investment on employee health is more difficult to measure. “It’s just like defending a corporate wellness program in a sense,” Bierbower said. “You can measure the low cost going in, but the results are more abstract.” For evidence, she turns to the correlation between poor dental and vision health and the incidence rate of heart disease, cancer and stroke — three of the top focuses of many preventive wellness programs. “More and more evidence continues to link cardiovascular disease and periodontal disease,” Bierbower said. “A new Humana plan recognizes the impact of periodontal disease upon overall health and allows for as many as four periodontal cleanings a year, while most plans offer just two.” Insurers are confident that the right dental and vision benefits plan will keep employees well. It’s just a matter of choosing the right one for your workforce. It is important to remember that the dental and vision care system is different from the medical care system, and carriers focused on dental have adapted accordingly to deliver cost-effective benefits that keep employees satisfied. Many dental carriers have developed infrastructures that may help them pay claims faster. Some carriers subcontract dental, which could result in added administrative cost. “Network is one of the most important considerations when choosing a dental or vision plan,” Shaw said. “It’s not only about the size of the network, it’s about making sure the network is made up of dentists and optometrists that the employees want to see.” Sarah Sipek is a Workforce associate editor. To comment, email editors@workforce.com.
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SPECIAL REPORT
Dental, Vision & Health Insurers
HOT LIST Health Insurers Listed alphabetically; compiled by Joe Dixon; editors@workforce.com
Company name & Web address
Total health care revenue for most recent 12 months
Total number of medical members
Number of members in employer-sponsored plans
AETNA aetna.com
$57.2 billion
23.5 million
19.5 million
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS bluecrossma.com
$6.5 billion*
2.8 million
2.3 million
BLUE CROSS BLUE SHIELD OF MICHIGAN bluecrossma.com
$22.9 billion
5.2 million
4.6 million
CIGNA** cigna.com
$27.3 billion
14.5 million
Would not disclose
FLORIDA BLUE floridablue.com
$12.2 billion
4.6 million
3.5 million
HIGHMARK highmark.com
$16.8 billion
5.3 million
4 million
HUMANA humana.com
$48.5 billion
14.2 million
1.9 million
UNITED HEALTHCARE uhc.com
$45.9 billion
29.5 million
25 million
Notes: Anthem, Assurant, Blue Shield of California and Kaiser Permanente either did respond to requests for information by deadline or declined to participate.
*As of January 2016 **Cigna did not release 2015 data by deadline. 2014 statistics are listed.
Source: Companies
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HOT LIST Dental Insurers Listed alphabetically; compiled by Joe Dixon; editors@workforce.com Number of employees and dependents covered by employer-sponsored plans
Number of client companies using these plans
Revenue from these plans for the most recent four quarters
CIGNA DENTAL cigna.com
13.9 million
Would not disclose
Would not disclose
DELTA DENTAL deltadental.com
52.9 million
122,127
Would not disclose
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA guardian.com
7.6 million
78,500
$2.3 billion
METLIFE DENTAL metlife.com
22 million
35,271
Would not disclose
PRINCIPAL FINANCIAL GROUP principal.com
1.6 million
30,500
$625 million
UNITED CONCORDIA DENTAL unitedconcordia.com
10.2 million
169,579
$1 billion
UNITED HEALTHCARE uhc.com
3.4 million
105,684
Would not disclose
Company name & Web address
Notes: Aetna, Ameritas, Assurant Dental, Kaiser Permanente and Sun Life Financial either did not respond to requests for information by deadline or declined to participate. Source: Companies
HOT LIST Vision Insurers Listed alphabetically; compiled by Joe Dixon; editors@workforce.com Number of employees and dependents covered by employer-sponsored plans
Number of client companies using these plans
Revenue from these plans for the most recent four quarters
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA guardian.com
7.6 million
78,500
$195 million
METLIFE VISION metlife.com
1.2 million
5,779
Would not disclose
293,100
7,750
$26 million
77.9 million
55,459
$3.5 billion
Company name & Web address
PRINCIPAL FINANCIAL GROUP principal.com VSP VISION CARE vsp.com
Notes: Assurant, Eyemed Vision Care, Davis Vision, Humana and Kaiser Permanente either did not respond to requests for information by deadline or declined to participate. Source: Companies
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2016
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SPECIAL REPORT
Dental, Vision & Health Insurers
ACA Update for 2016
DATA BANK
By Cary E. Donham The Affordable Care Act has now survived two U.S. Supreme Court challenges since its approval in March 2010 and is taking full effect. What’s in store for 2016? The employer mandate becomes effective for employers with 100 or more full-time-equivalent employees, or FTEs, as well as smaller businesses with 50 to 99 FTEs and average aggregate annual wages of more than $250,000. Now, employers with 50 or more employees must provide health care insurance coverage for employees and dependents up to age 26 to 95 percent of FTEs. The mandate does not apply to employers with 49 or fewer FTEs. Employers also should be aware of other ACA requirements. For example, employers governed by the mandate must offer a health insurance plan that meets “minimum value” and “affordability” standards. In addition, employees eligible for health care coverage must be enrolled within 90 days of beginning employment. A longer waiting period is not allowed. Employers who fail to meet the 95 percent coverage mandate will be assessed a penalty on a monthly basis, known as an employer shared-responsibility payment. The penalty can total up to $2,000 annually per full-time employee not covered by a qualified health plan, which meets at least the minimum ACA standards. The penalty has increased each year by set increments, but beginning next year, it will adjust for inflation. In addition, employers that do not meet the minimum value and affordability standards can be assessed a penalty equal to $3,000 for each full-time employee who receives a premium tax credit even though the employer offered health insurance coverage to at least 95 percent of its employees. While the number of FTEs is used to determine if an employer must comply with the mandate, the penalty is calculated based upon full-time workers, and not FTEs. Specifically, employees who work at least 30 hours per week, or whose service hours equal at least 130 hours a month for more than 120 days in a year are considered full time. Employers with fewer than 25 FTEs and average annual wages of less than $50,000 qualify for employer tax credits if they elect to provide coverage. Employers with fewer than 10 FTEs and average annual wages of less than $20,000 qualify for the full credit of up to 50 percent of their share of employer premiums. To be eligible for a tax credit, the employer must contribute at least 50 percent of the total premium cost or 50 percent of a so-called “benchmark premium.” In addition, information reports for self-insuring employers and other coverage providers are due in 2016, and the IRS recently extended the time for employers to meet their 2016 reporting requirements. Under transition relief issued by the IRS on Dec. 28, these reports must now be furnished to individuals by March 31 and filed with the IRS by May 31 via paper and by June 30 for electronic filers.
Cary E. Donham is a partner at Taft, Stettinius and Hollister. To comment, email editors@workforce.com.
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Teeth in the Game The percentage of dental plans is expected to drop in 2016 in most categories while vision remains steady. T YPE
2015
OF P L A N
2016
Dental schedule of allowance plan
4.0% p 4.2%
Dental fee for service/indemnity plan
5.4% q 3.5%
Dental provider organizations
4.7% q 3.5%
Dental maintenance organizations
4.4% q 3.2%
Vision schedule of allowance plan
2.7% = 2.7%
Vision reasonable & customary plan
2.6% p 3.1%
Source: Segal Consulting’s 2016 Segal Health Plan Cost Trend Survey
More to Pay? They Stay Away As cost-sharing increases, more consumers are forgoing care. Percentage of consumers forgoing care
29%
$1,200
40%
$680
Average in-network deductible
2009
Average in-network deductible
2015
Source: PricewaterhouseCoopers’s 2015 Health and Well-being Touchstone survey
Cheaper Options Consumers with employer-based insurance are seeking more affordable options.
38% 62%
Asked about an alternative option
(Options included asking for a medical discount, cheaper alternative to a prescription drug and appealing an insurance decision)
None
(did not seek cheaper options)
Source: PricewaterhouseCoopers’s 2015 Health and Well-being Touchstone survey
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2016
ROADMAPS Roadmaps is a practical guide for HR leaders on how to plan, implement and review key talent management programs. This Roadmap offers advice on how to build a healthy wellness plan. To learn more about this and other Roadmaps, visit Workforce.com/Roadmaps.
Building a Healthy Benefits Plan
Plan, Do, Review Plan •
Assess your employees’ needs. Is there literally a lot of heavy lifting involved? Or, is your workforce largely confined to desks? What takes up your largest workers’ compensation claims?
•
Learn how the Affordable Care Act affects your workforce. By now, you should have a good handle on the effects of Obamacare on your organization. With new forms like the 1095-C and the so-called “Cadillac” tax, the ACA is having a dramatic effect on how health care plans are managed.
•
What about wellness? If you haven’t implemented a wellness program in your organization, you’re lagging behind your competitors. But that doesn’t mean you are too late. Assess several vendors and consider your options.
Do •
Communicate. Then communicate some more. It has been said that people would rather clean their toilet than deal with their benefits. And while this might sound obvious, HR needs to communicate frequently and consistently with employees regarding the benefits program. Is there an employee assistance program available and how does it work? What’s the coverage on such things as vision and accidental death? Are there options to include elder care or child care assistance?
•
Motivate. Then motivate some more. Just because you put apples and bananas in the break room doesn’t mean you’ve set the motivation health machine in motion. Quarterly health fairs, motivational speakers, wellness tips and recipes placed in employee communications are all part of the repetitive drum you must beat to make wellness integral to your workplace.
•
Schedule an ergonomic overhaul. Look around. When was the last time your organization updated its office furniture? Not only will a room full of new chairs and standing desks improve morale, but also it will modernize the look and feel of the office environment and help boost productivity.
I
n a job market where a recent survey noted that 1 in 5 employees are determined to land a new job this year, a robust benefits package could go a long way to help retain the worker who’s contemplating a move or entice the ones who are on the hunt for a new opportunity. Building better benefits offerings will take time, effort, research and good old-fashioned communication. As in, talking to your employees. What do they want? What do they need? One consideration they likely will want is a comprehensive wellness plan. Wellness is no longer trendy or a fad, but organizations without a wellness plan should analyze whether it’s a fit for its employee population. Some employers are taking preventive steps with nagging health issues such as back pain by offering employees incentives to look at other options before surgery.
This Workforce Roadmap helps encapsulate the themes and ideas of what was written in this special section on developing and maintaining a well workplace. march
2016
Review •
Don’t put all your wellness eggs in one ROI basket. Managers want to see the return on investment. Given that it can be a costly, complicated process with murky results, focus on “VOI,” or value on investment. Did you cut absenteeism? Are there fewer claims among the diabetic population? Tell the story through the progress you’re making on employees’ individual health.
•
Track your ACA compliance. Federal agencies are stiffening compliance rules with each passing year. Consult your benefits advisers regularly to measure your progress.
•
Quit fiddling with it. Don’t make changes unless something is actually broken. Employees become suspicious when you constantly revamp a program. If you must make adjustments, change one element at a time and track the impact on the entire program before implementing it.
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WELLNESS 2.0 continued from page 41 ties,” Grile said. “We opened an employee care clinic with on-site mental health counselors, health coaches and nurse advocates.” This spring, the hospital plans to offer a six-week cognitive behavioral class to treat insomnia. Participants will learn relaxation techniques, habits for good sleep and how to cope with nightmares. With workplace stress levels rising and costing employers billions in lost productivity each year, the demand for programs that help employees manage their mental health is growing. The concept of mental resilience is generating interest among employers looking to teach employees how to weather tough times. “Employers are making the connection that our heads are connected to our bodies,” said Jan Bruce, CEO of MeQuilibrium, a Boston-based firm that developed an online employee stress management program. “We spend a lot of time motivating people, creating incentives to take better care of them-
selves physically but it doesn’t get the job done. The prevalence of stress has changed radically in the past five years, and that has catapulted employers and people in HR to think about the importance of addressing the emotional well-being of the population.” All of these developments — from dropping the carrots and sticks to recognizing the effect of mental and emotional health on the bottom line to redefining value — is a sign that wellness programs are maturing, and that bodes well for their future, Mirabito said. “Wellness experts and employers have a deeper understanding of how wellness contributes to the organization,” she said. “There’s a better understanding of the costs of chronic illness, not just in terms of outof-pocket health care costs, but the human toll and impact on the organization.” Rita Pyrillis is a writer based in the Chicago area. To comment, email editors@workforce.com.
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w o r k f o r c e . c o m | Workƒorce
49
LAST WORD
Rick Bell
WELLNESS, SCHMELLNESS
E
mployers, I’m not sure if you have hearts of gold, are the world’s biggest enablers, or are just dupes. Corporate wellness programs in a relatively short time have become as common and accepted within the walls of U.S. organizations as March Madness basketball pools and Cyber Monday holiday shopping. Over the years, I have given employers props for instituting these programs. We all want to be healthy, right? No one wants to be sick. As a former co-worker once told me, “Your worst day at work is better than your best day in the hospital.” Do the right thing, corporate America!
MUCH LIKE A FAMILY CAN ENABLE AN ALCOHOLIC TO DRINK, YOUR WELLNESS PROGRAM COULD BE ENABLING YOUR EMPLOYEES TO AVOID TAKING RESPONSIBILITY FOR THEIR HEALTH. But I’m not sure you’re doing the right thing. In fact, much like a family can enable an alcoholic to drink, your wellness program could be enabling your employees to avoid taking responsibility for their health. I don’t need or expect my company to spend money that could boost salaries or upgrade office equipment so I can have free apples, bananas and bottles of vitaminwater in the break room. So why spend company cash to fund a 5K race that at best will draw a sliver of the employee population — the bulk of whom are either daily runners or are silently screaming while they are shamed into participation? Wellness is not an initiative; it’s not posters on a wall, disease prevention plans or wearable devices. Wellness is a state of mind. More specifically, my state of mind. I don’t need my employer urging me to exercise and eat my veggies.That’s what moms are for. Employers, you want to be Don Quixote and tilt at wellness windmills? Go for it, and while you’re traipsing across the countryside, put Sancho Panza on a weight-loss regimen, too. There’s that pesky fuzzy math when the wellness talk turns to ROI that time and again experts argue to instead analyze value. I’m also the sneering cynic when I hear wellness coupled with “improved productivity.” Sure, I ate a cup of creamed broccoli instead of double-fisting burgers, but who’s really profiting from my supposedly better health? Despite all the stretching, I still 50
Workƒorce | w o r k f o r c e . c o m
have a chronically creaky back; I’m worried to death about my retirement account; and eight hours of staring at a computer makes me feel like my eyes are about to fall out of my head. You may be wondering at this point, what set this guy off? Was the medical marijuana secretly laced with paraquat? A bad batch of quinoa at Burrito Beach? Crushed in a footrace by his 5-year-old grandchild? All are distinct possibilities — especially losing to a 5-year-old — but there was a national Dialogue on Men’s Health in January. Wow, that’s extremely progressive, I thought, until I read one paragraph from an event release that readjusted my thinking on employer-sponsored wellness: “Lack of health care and an overall lack of engagement among American men is contributing to a large-scale health deficit in the United States. Men have higher mortality rates for 9 of the top 10 causes of death, and men also die five years earlier than women, on average.” Sound the alarm! Crisis ahead! Boss, create a wellness program to level that playing field! Um, no. A Sunday morning robo-text from a wellness provider won’t shake a guy out of a football-induced coma to pound out a 5-mile run. If you buy into that, take a toke of this paraquat-laced blunt. News flash: My health is not my boss’ responsibility. That’s on me. And the sooner I take responsibility for my health and well-being, the better my chances to outlive the lady making my grilled chicken and quinoa burrito. Let’s not kid ourselves. Employers stopped being Dad to their workers about the time Reagan was re-elected as president. Since then they’ve eschewed pensions and full health benefits, pushing employees to “be a better consumer” of defined contribution retirement plans and high-deductible health plans. It’s OK to shirk responsibilities that perpetuated several generations, but then they make up for it by being guilt-tripped into pulling Pepsi and Diet Rite in favor of Kombucha and Odwalla? Maybe you truly think wellness is the right thing to do. I won’t say that’s bad; just be consistent. Don’t feed employees a steady diet of wellness in the name of enhanced productivity while simultaneously saddling them with being “smart shoppers” to plan and fund their health and retirement. Maybe you feel like a good corporate citizen. But then again, you might just be an enabler. Or duped into believing a wellness plan will cure your employees’ ills when, like I said, that’s on me. Rick Bell is Workforce’s managing editor. To comment, email editors@workforce.com.
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